Pain management: the use of Patient Controlled Analgesic Systems

Sharon Wood, Lecturer in Pain Care, University of Leeds will be leading this week’s ENB twitter chat on Wednesday the 1st of April January between 8-9pm UK time focusing on ‘the use of patient controlled analgesic systems’. Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc or @EBNursingBMJ, or better still, create a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

Patient controlled analgesia systems (PCAS) have been routinely used to manage post-operative pain in the UK for over 20 years; despite this patients continue to report unrelieved post operative pain. There are no national standards or recommendation for PCAS in the UK leading to individual hospital Trusts developing their own clinical guidelines. This may be one of the factors that contribute to under-managed postoperative pain. Yet, PCAS have benefits compared to continuous analgesia infusions, which include increased user satisfaction and greater user control, no delay between the perception of pain and administration of analgesia, an overall reduction in analgesia used, and in the case of opioids less sedation (Demirel et al., 2014).

PCAS is traditionally used for postoperative pain in the UK but has the potential to be an effective strategy in additional pain management situations, for example, pre-operative pain management for patients with fractured hip. A recent study found PCAS an effective strategy for managing pain in the Emergency Department (Birnbaum et al., 2012).

PCAS, usually with a background infusion, is an effective and safe method of administering analgesics in children, particularly in children 11- 18 years of age, with a high degree of child and family satisfaction. Nurse-controlled analgesia (NCA) is also used in children’s settings, with the nurse, within prescription limitations, able to administer controlled boluses of analgesic drug at times of increased pain. Nurses should involve the child, if appropriate, and parents about the need for additional but it is the responsibility of the nurse to press the button to administer the drug,

Question for consideration:

What factors have you encountered that may have contributed to under-managed post-operative pain which PCAS? Have you any possible solutions to mange this more effectively?
Have you used PCAS for other groups of patients with pain and if so what were the strategies that were employed and were these effective?
Are there any clinical situations where you have found NCAS an effective pain management strategy or it has value as an option in clinical practice?

References

Birnbaum, A., Schechter, C., Tufaro, V., Touger, R., Gallagher, E. J. and Bijur, P. (2012) Efficacy of Patient-controlled Analgesia for Patients With Acute Abdominal Pain in the Emergency Department: A Randomized Trial. Academic Emergency Medicine, 19: 370–377.

Demirel, I., Ozer, A. B., Atilgan, R., Kavak, B. S., Unlu, S., Bayar, M. K. and Sapmaz, E. (2014) Comparison of patient-controlled analgesia versus continuous infusion of tramadol in post-cesarean section pain management. Journal of Obstetrics and Gynaecology Research, 40: 392–398.

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