Perioperative Pharmacology: Patient‐Controlled Analgesia

Abstract

Patient-controlled analgesia (PCA) is an effective treatment option for reducing pain, but PCA errors can be quite serious. Opioid analgesics are among the most effective pain relievers available, but all have contraindications and can have adverse effects, including respiratory depression and other effects on the central nervous system. Practitioners must weigh the potential benefits of PCA use against the risks. Errors associated with the PCA process have been documented in each phase of the medication-use process; therefore, practice improvements in prescribing, transcribing, dispensing, administering, and monitoring PCA may reduce the likelihood of errors. Perioperative nurses can make important contributions to safe PCA use by establishing standardized processes to help ensure positive patient outcomes in pain management.

Postoperative Pain Management

“…Each drug has its own parameters when being administered through patient controlled analgesia pumps. For example, the parameters for morphine are "1-mg to 2-mg bolus, six minute lock-out interval, and self-administration dose of 1.5mg to 3mg per hour" (Hicks, R., Hernandez, J., & Wanzer, L., 2012). Hydromorphine is stronger than morphine since 1-mg to 2-mg is the same as 10-mg of morphine.…”

“…Hydromorphine is stronger than morphine since 1-mg to 2-mg is the same as 10-mg of morphine. On the other hand, fentanyl is about "75 to 100 times more potent than morphine" (Hicks, R., Hernandez, J., & Wanzer, L., 2012). Common opioid side effects include: constipation, respiratory depression, sedation, dizziness, nausea, vomiting, and physical dependence.…”