Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia

Abstract

This review assesses four interrelating aspects of patient-controlled analgesia (PCA), a long-standing and still widely used concept for postoperative pain management. Over the years, anaesthesiologists and patients have appreciated the benefits of PCA alike. The market has seen new technologies leveraging noninvasive routes of administration and, thus, further increasing patient and staff satisfaction as well as promoting safety aspects. Pharmaceutical research focuses on the reduction or avoidance of opioids, side effects, and adverse events although influence of these aspects appears to be minor. The importance of education is still eminent, and new educational formats are tested to train healthcare professionals and patients likewise. New PCA technology can support the implementation of efficient processes to reduce workload and human errors; however, these new products come with a cost, which is not necessarily reflected through beneficial budget impact or significant improvements in patient outcome. Although first steps have been taken to better recognize the importance of postoperative pain management through the introduction of value-based reimbursement, in most western countries, PCA is not specifically compensated. PCA is still an effective and valued technique for postoperative pain management. Although there is identifiable potential for future developments in various aspects, this potential has not materialized in new products.

Development of a nomogram for predicting acute pain among patients after abdominal surgery: A prospective observational study

“…Third, figures vary because of analgesic technique. Studies have confirmed that the application of PCIA could greatly improve the level of post-operative acute pain management (Kikuchi et al, 2019;Nardi-Hiebl et al, 2020). In this study, PCIA was used to control post-operative pain in most patients (82.10%).…”

Development of smart infusion pumps: State of the art and future perspectives

“…Patient-controlled analgesia (PCA) is a technique that allows patients to self-administer medication within predetermined limits as needed. It is currently a more mature semi-closed-loop intravenous drug delivery method 56 . It integrates real-time monitoring equipment and feedback modules, which can automatically adjust drug doses based on patient feedback or vital signs.…”

Control inadecuado del dolor agudo postoperatorio: prevalencia, prevención y consecuencias. Revisión de la situación en Latinoamérica

“…El inadecuado control del dolor en el paciente en general y especialmente del postquirúrgico está sobre la mesa en distintos centros sanitarios mundiales (incluyendo a los latinoamericanos desde hace décadas), pese a la implementación en el uso de dispositivos de analgesia controlada por el paciente (PCA) (35) o a la instauración de los primeros estándares y guías como la «Achieving Improved Measurement» del Canadian Council on Health Services Accreditation (36) , o la creación paulatina de unidades especializadas en dolor en cada centro hospitalario (37) . Unidades con instalaciones adecuadas, equipos multidisciplinares (médicos, cirujanos, enfermeros), estrategias propias y recursos de toda índole tales como registros clínicos (38) , nuevas terapias y programas de rehabilitación (39) o grupos de trabajo como PROSPECT (Procedure-Specific Postoperative Pain Management), que brinda a los profesionales de la salud recomendaciones prácticas y específicas por procedimientos para facilitar la toma de decisiones en todas las etapas del período operatorio (40) , también forman parte de los intentos por mejorar el control del dolor en el terreno postoperatorio.…”