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Patient Controlled Analgesia - Essay Example

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No pain management method exists today that eases postoperative pain 100% of the time. Compared to 10 years ago, on the other hand, patients at present can be made enormously comfortable with fewer side effects. Anaesthesiologists have pioneered advances in pain management, including better understanding of pain pathways, newer drugs and drug combinations as well as more effective pain-relief techniques such as Patient Controlled Analgesia (PCA)…
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Download file to see previous pages 1989). This was first introduced in 1970 into obstetric practise where the patient simply controlled the administration of i.v. pethidine by operation of a spring loaded clamp on an infusion set! In a way, it mimics the use of the PCA 50:50 nitrous oxide/oxygen gas mixture (Entonox). Patient Controlled Analgesia refers to a particular type of breakthrough dosing used when a predetermined parenteral drug dose is injected following the push of a button. In reality not all PCA breakthrough doses are controlled or administered by patients, who may be physically or mentally impaired. Clinicians or families may administer the breakthrough dose in such cases, which is still often (erroneously) called the PCA dose. Thus, in practice parenteral breakthrough doses, when programmed by a pump are often referred to as PCA doses, regardless of who administers the dose. In a general sense, patient-controlled analgesia refers to a process where patients can determine when and how much medication they receive, regardless of analgesic technique. On the other hand, 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. Patient-controlled analgesia produces a modest improvement in pain relief over a 24 hour period compared with conventional analgesia. It is preferred by patients, and is not associated with additional side effects. For many patients, mainly those having major abdominal surgery, PCA offers the greatest pain relief and the most flexibility. A PCA device consists of a pump, a reservoir to hold the drug and a handset with a button that administers a dose of drug when activated by the patient. Patient receives pain medication by pressing a button permitting the patient to take control of the pain. This eases the anxious waiting for pain relief and the peaks of pain (Macintyre PE, Runciman WB, Webb RK. 1990).
Patient controlled analgesia is widely used for postoperative pain relief in both children and adults. Unfortunately, postoperative pain control is often the last concern discussed with patients even though it can become the major concern after the operation is performed. Most patients are more worried concerning the potential surgery and anaesthetic complications prior to surgery, than they are with pain control after surgery. Therefore, patients are often overshadowed by the patient's anxiety regarding the procedure Postoperative pain management actually starts preoperatively. The anaesthesiologists and surgeon will decide on a plan prior to the surgery. A major deciding factor with regard to choosing an appropriate plan will depend on whether the patient is to be discharged the same day (day surgery) or will be admitted after surgery. With right preoperative teaching and encouragement, children as young as 6 to 7 years of age can independently use the PCA pump to provide good postoperative pain relief (Kluger and Owen H. 1990). Children between the ages of 4 and 6, though, generally require encouragement from the parents and nursing staff to push the button before anticipated painful movements or ...Download file to see next pagesRead More
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