Patient Controlled Analgesia For Adults

GENERAL INFORMATION:

What is it? Patient controlled analgesia (ah-null-G-z-uh) or "PCA" is a way to get pain medicine without the need for repeated injections (shots). A PCA is a machine set up by caregivers. A PCA pump lets you have some control over pain medicine delivery. When you need pain medicine, you can push a button and the pump will give pain medicine to you. It is set up to allow pain medicine to be given by the person the machine is attached to. Pain medicine may also be given slowly and continuously. If pain medicine is given slowly and continuously, the patient may also push the button to get more medicine. The pump is set up to not give you too much medicine, or give you medicine too often.

When is PCA used to control pain? PCA can be used to treat pain from many different conditions. It can help decrease acute (short-term) pain, like after surgery or an accident. Chronic (long-term) pain, like cancer pain may also be treated with PCA. Your caregiver may want you to use a PCA at home to help control your pain.

How does PCA work? The PCA is a small, lightweight, battery-operated pump attached to a syringe filled with pain medicine. The syringe is hooked up to an IV tube. Caregivers will put a small catheter (a thin tube) under your skin, into a vein (blood vessel). An IV tube is connected to this, and you will get pain medicine through this tube. There are different ways to get the medicine:

• A "basal rate" is a small amount of pain medicine running into the IV tube all the time.
  
  
• Sometimes a button is hooked up to a cord connected to the PCA pump. When you feel pain, you push the button. A small dose of pain medicine goes into your vein through the IV. The pump is usually attached to the same pole as your IV so you can move it easily and safely with you.
  
  
• You may have a basal rate, and a PCA for when you need more pain medicine.

How is PCA different from an injection?

• With PCA, small amounts of pain medicine can be given continuously or as needed. The medicine gets into your blood stream faster than an injection. You may still have pain, but it should be an amount that is manageable for you.
  
  
• With an injection (hypo or shot into a muscle), you may have to tell your caregiver that your pain is getting worse. You may have to wait for the medicine. With an injection, you may get a larger amount of pain medicine at one time. Your pain may return before you can get another shot, since time (usually hours) must pass between injections.

How safe is PCA?

• PCA is very safe. The machine has a tiny computer in it that is set by caregivers depending on your weight, age, and other things. The pump will only allow a specific amount of medicine to be given within a specific time. The machine has a "lockout" period that prevents you from getting a dose of medicine too soon. You may push the button many times, but the pump will only give you medicine in keeping with the rules caregivers have set. Sleepiness and very slow breathing may be signs of too much pain medicine. Being uncomfortable and restless may be signs of not enough pain medicine. Your caregiver will watch you closely for these and other signs, and the amount of medicine you get when you push the button may be changed.
  
  
• Some people worry that they may become addicted to pain medicine. Studies have shown that patients using PCA often use less medicine. PCA may only be used for a few days depending on the injury or illness you have. Before your PCA is removed, caregivers will talk to you about your pain. Your caregiver will decide with you what may be used to manage it.

Who should press the button? Current guidelines state that only the patient should press the PCA button for pain relief . If you think that someone else should press the button for you, talk to your caregiver. Tell your caregiver if you are still uncomfortable a few minutes after pushing the button. Caregivers can usually tell by your heartbeat and breathing if you need more medicine. Caregivers can also tell if you are getting too much pain medicine.

Will taking pain medicine slow my recovery? No. Pain medicine is needed and important after an injury or surgery, or during some illnesses. PCA may allow you to rest comfortably. Being comfortable helps you to breathe more deeply and may help you heal faster. With PCA, you may not use as much medicine as when you receive shots for pain. A PCA may actually control your pain better, and keep you more alert and awake. With a PCA, you may want to start moving around sooner. Being active helps stop blood clots from forming, and may help you to get better faster.

Are there any side effects? You may have side effects from any pain medicine, such as nausea (upset stomach), itchy skin, or trouble urinating. Caregivers will watch you closely and work with you to prevent and treat these problems.

Call your caregiver if:

• You are very sleepy most of the time.
  
  
• You are vomiting (throwing up) often.
  
  
• Your pain is not at a manageable level.
  
  
• The place where your IV is put into your skin is painful, warm, red, swollen or bleeding.
  
  
• You see blood increasing in the tube going to the pump.
  
  
• You see that your pump has no more medicine in it.
  
  
• Your pump has an alarm that is going off.
  
  
• You need to change your clothing or get out of bed, and you need help.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your pain and how a PCA can be used to treat it. You can then discuss treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.

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