Safety and efficacy of patient-controlled analgesia

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Abstract
In a general sense, patient-controlled analgesia (PCA) refers to a process where patients can determine when and how much medication they receive, regardless of analgesic technique. However, the term is more commonly used to describe a method of pain relief which uses disposable or electronic infusion devices and allows patients to self- administer analgesic drugs, usually intravenous (i.v.) opioids, as required. The main focus of this review will be i.v. PCA. The overall effectiveness of any analgesic technique depends on both the degree of pain relief that can be achieved and the incidence of side effects or complications. Therefore, factors affecting efficacy and safety of PCA are often inextricably linked. This review will consider: d analgesic efficacy—compared with conventional meth- ods of pain relief in post-operative patients (including pain relief, analgesic use and cost comparisons), when used in non-surgical patients, and with opioid adminis- tration by other than the i.v. route; d patient outcomes—patient satisfaction and post-operative morbidity; d patient factors that may affect safety and efficacy— including patient age, psychological characteristics, con- current disorders, opioid tolerance, and inappropriate use of PCA; d equipment factors that may affect safety and efficacy— including equipment design and malfunction; d medical and nursing staff factors; d the PCA 'prescription'—including programmable vari- ables and drugs used.