Regional Anesthesia & Pain Management (RAPM)

Patient Information

Patient Controlled Analgesia (PCA)
A PCA device is a computerized delivery system for opioids like morphine. When it has been programmed, the PCA device will deliver a small amount of pain medication (usually morphine) into your intravenous whenever you press the attached button. The concept is simple: if you feel pain, you press the button. You are in control. This saves you from having to call a nurse every time you need some pain medicine. Each time you press the button the pain medicine is delivered painlessly.

The PCA device will be started in the recovery room immediately after you awake from your operation and you will go to the ward with it.

How do I to use it?
Any time you feel pain you can press the button so that a small quantity of morphine is delivered into your intravenous. After you press the button it might take 5 to 10 minutes for you to feel some relief. Ideally, you will not have to press the button more than one to three times an hour. Your nurse and the Acute Pain Service will make sure you are using the PCA correctly. The PCA device will be programmed to suit your needs and if necessary the doses will be adjusted.

What drugs are used in a PCA device?
The usual drug in the PCA is morphine. If you cannot tolerate morphine your anesthesiologist will talk to you about other options.

What are the benefits of PCA?

• You do not need to get painful shots into your muscle or under your skin each time you need pain medicine.
• You do not have to wait for a nurse to answer your call-bell and then have to wait for the nurse to bring you your pain medicine.
• You have more control over your pain and you can press the button anytime you feel pain.
• You can press the PCA button before you are going to move or do something that is painful. This is a real advantage over other slower methods of pain control.

How long will I need it for?
The PCA device will be used for as long as you need it. When you can tolerate a steady diet the Acute Pain Service may switch you over to medications that you take by mouth. If you cannot take medication by mouth the PCA device will normally be used as long as you have an intravenous. You cannot go home with a PCA device so other ways of controlling your pain will be started to prepare you for going home.

Does it take special skills to be able to use a PCA?
No. If you understand how the system works, and you can press the button when you feel the need to, you are a candidate for a PCA. Your Acute Pain Service doctor or nurse will also help you to assess your ability to use the PCA.

What are the risks?
The risk of any serious side effect with proper use of the PCA is very rare. If you use the PCA for reasons other than pain control (e.g. to make yourself feel sleepy) you might slow or stop your breathing and this can be quite dangerous. There can also be problems with PCA devices if a family member presses the button instead of the patient. The PCA device is to be controlled by the patient only!

You should not use the PCA button if you are too sleepy or feel confused, or if you are having ‘gas pain’.

Can I overdose if I press the button too much?
There are a number of safety features to prevent this from happening:

• When you press the button you will only receive one pre-set dose of morphine: no matter how many times you press the button, the machine will not deliver another dose of morphine for at least 5 minutes. This safety time period is called a ‘lock-out’.
• The machine is normally pre-set to deliver a maximum amount of morphine in any 4 hour period.
• If you need more than this amount the nurse will have to notify the Acute Pain Service.
• The nurses will monitor your vital signs regularly and notify the Acute Pain Service if you are having any difficulty.

I still feel afraid to press the button on my own. What should I do?
Remember that people as young as age 5 have used the PCA device! Keep an open mind about this technique. Ask to see the machine when you come for your preoperative visit. After your operation, your nurse will remind you how the device works and will make sure you are using it properly.

What are the side effects caused by morphine?
There are a number of side effects that can occur due to morphine:

• Nausea or vomiting
• Drowsiness/confusion
• Itchiness
• Constipation
• Difficulty urinating

If any of these side effects occur, there are methods to help treat them.

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