PATIENT-CONTROLLED ANALGESIA ACTUAL EXAM QUESTIONS AND ANSWERS.

Doses delivered IV into spinal canal by some type of machine (pump) controlled by patient ... Advantages of PCA equivalent or increased analgesic effects lower incidence of side effects use less of the drug PCA used for Acute post-surgical pain Cancer & chronic pain Loading dose of PCA Initial single large dose given to establish analgesia (brings levels of drug into therapeutic window) Demand dose of PCA Amount of drug self-administered each time Lockout Interval Minimum amount of times allowed between each demand dose One and four hour limits PCA system may be set to limit total amount in a one or four hour period Background infusion rate Small amount of drug infused continuously Discourage for most patients Successful vs. total demands Success when patient activates PCA system & receives a dose Demands made during lockout interval are not successful but are added to get total primary medication for PCA Morphine meperidine, tramadol, etc. Types of PCA Administration Intravenous (PCIA) Needle inserted into peripheral vein Epidural (PCEI) Directly into area outside of meninges surrounding spinal cord Transdermal (PCTA) Patch on skin activated by pressing button Similar to other iontophoresis techniques Regional (PCRA) Directly into specific anatomical site PCA vs. Traditional Analgesic Administration Provides adequate analgesia without substantial increase in side effects More patient satisfaction with PCA Ambulate sooner & have shorter hospital stays with PCA Actually use less total drug with PCA PCA decreases need for involvement of other health professionals PCA Problems & Side Effects No increased side effects compared to traditional administration Transient sensory & motor loss may occur with local anesthetics Operator errors Patient errors Mechanical problems Not usually successful in controlling pain in people with hx of opioid addiction