Patient Controlled Anesthesia

The advent of PCA has significantly improved the management of post-operative pain following all types of major surgery. PCA allows the patient to control when and if pain medication is desired. Standard "on call" pain medication must first be requested by the patient. Then, the nurse must check the orders and time to be sure it is all right to give the medication and determine what dose to give. It usually takes 10-30 minutes to obtain the medication.

The PCA device is a computer controlled injection system that is hooked up to a standard IV line used in all hip and knee replacement patients for routine fluid administration. The device is triggered by the patient, using a push button, when he or she desires pain medication. The devise is programmed by the anesthesiologist (or surgeon) to administer a dose of morphine or demerol on demand by the patient. In addition, a basal rate of constant infusion can be used to give some level of continuous pain relief.

If the medication is not effective, the anesthesiologist (or surgeon) can order an adjustment to the programmed settings as needed. The computer program will determine the timing and frequency of the dose. All the patient has to do is determine if and when he wants pain medication, and push the button. Since the medication is administered through the IV, it will take affect within minutes.

The benefits of PCA are more effective pain control after surgery. The risks are few but deserve mention. Although the chances of over dosage are greatly reduced with PCA, it can still occur. Over dosage can cause breathing difficulties, so while using PCA you will be given oxygen to breathe and the nurse will monitor your respiration and degree of sedation. Nausea and itching can also occur but are usually well managed with other medications. Urination can be difficult when using PCA, so a catheter is placed in the bladder at the time of your surgery and maintained until the PCA is discontinued.

Drs’ Bargar and Blumenfeld usually use PCA as an adjunct following spinal and/or general anesthetics. The spinal narcotics are effective post operatively for 12-18 hours. Therefore if a spinal anesthetic was used, the PCA is usually started at 12 hours following surgery. For general anesthesia alone, PCA is started as soon as you leave the recovery room. It is continued until the second or third post-operative day as needed by the patient.