0
January 8, 1988, Vol 259, No. 2 >
ARTICLE | January 8, 1988

Use of Patient-Controlled Analgesia for Management of Acute Pain FREE

Paul F. White, PhD, MD
[+] Author Affiliations

Reprint requests to Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305 (Dr White).


JAMA. 1988;259(2):243-247. doi:10.1001/jama.1988.03720020045035
Text Size: A A A
Published online
Article
References

Patient-controlled analgesia (PCA) provides improved titration of analgesic drugs, thereby minimizing individual pharmacokinetic and pharmacodynamic differences. Patient-controlled analgesia decreases patient anxiety resulting from delays in receiving pain-relieving medication and from the slow onset of analgesic action when these drugs are administered either intramuscularly or in the extradural space. With PCA therapy, patients are reportedly able to maintain a near optimal state of analgesia with minimal sedation and few side effects. The potential for overdose can be minimized if small bolus doses are used with a mandatory lockout interval between successive doses. Finally, studies of the cost-effectiveness of PCA therapy are important if this therapeutic approach is to achieve more widespread acceptance.

(JAMA 1988;259:243-247)

REFERENCES

1 +
Sechzer PH:  Objective measurement of pain. Anesthesiology 1968;;29:209-210.
2 +
Forrest WH Jr, Smethurst PWR, Kienitz ME:  Self-administration of intravenous analgesics. Anesthesiology 1970;;33:363-365.
3 +
Sechzer PH:  Studies in pain with analgesic demand system. Anesth Analg 1971;;50:1-10.
4 +
Keeri-Szanto M:  Apparatus for demand analgesia. Can Anaesth Soc J 1971;;18:581-582.
5 +
Keeri-Szanto M, Heaman S:  Postoperative demand analgesia. Surg Gynecol Obstet 1972;;134:647-651.
6 +
Finley RJ, Keeri-Szanto M, Boyd D:  New analgesic agents and techniques shorten postoperative hospital stay. Pain 1984;;2:S397.
7 +
Evans JM, MacCarthy J, Rosen M, et al:  Apparatus for patient-controlled administration of intravenous narcotics during labour. Lancet 1976;; 1:17-18.
8 +
Bahar M, Rosen M, Vickers MD:  Self-administered nalbuphine, morphine and pethidine: Comparison by intravenous route following cholecystectomy. Anaesthesia 1985;;40:529-532.
9 +
Sprigge JS, Otton PE:  Nalbuphine versus meperidine for postoperative analgesia: A double-blind comparison using the patient-controlled analgesic technique. Can Anaesth Soc J 1983;;30:517-521.
10 +
Hull CJ, Sibbald A, Johnson MK:  Demand analgesia for postoperative pain. Br J Anaesth 1979;;51:570-571.
11 +
Hull CJ, Sibbald A:  Control of postoperative pain by interactive demand analgesia. Br J Anaesth 1981;;53:385-391.
12 +
White DC, Pearce DJ, Norman J:  Postoperative analgesia: A comparison of intravenous on-demand fentanyl with epidural bupivacaine. Br Med J 1979;;2:166-167.
13 +
Kay B:  Postoperative pain relief: Use of an on-demand analgesia computer (ODAC) and a comparison of the rate of use of fentanyl and alfentanil. Anaesthesia 1981;;36:949-951.
14 +
Welchew EA, Hosking J:  Patient-controlled postoperative analgesia with alfentanil: Adaptive, on-demand intravenous alfentanil or pethidine compared double-blind for postoperative pain. Anaesthesia 1985;;40:1172-1177.
15 +
Lehmann KA, Gördes B, Hoeckle W:  Postoperative on-demand analgesia with morphine. Anaesthesist 1985;;34:494-501.
16 +
Lehmann KA, Jung C, Hoeckle W:  Tramadol und Pethidin zur post-operativen Schmerztherapie: Eine randomisierte Doppelblindstudie unter den Bedingungen der intravenösen On-Demand Analgesie. Schmerz 1985;;3:88-100.
17 +
Tamsen A, Hartvig P, Dahlstrom B, et al:  Patient-controlled analgesia therapy in the early postoperative period. Acta Anaesthesiol Scand 1979;;5:462-470.
18 +
Tamsen A, Hartvig P, Fagerlund C, et al:  Patient-controlled analgesic therapy: Clinical experience. Acta Anaesthesiol Scand 1982;;74:157-160.
19 +
Tamsen A, Hartvig P, Fagerlund C, et al:  Patient-controlled analgesic therapy: Pharmacokinetics of pethidine in the pre- and postoperative periods. Clin Pharmacokinet 1982;;7:149-163.
20 +
Dahlstrom B, Tamsen A, Paalzow L, et al:  Patient-controlled analgesic therapy: Pharmacokinetics and analgesic plasma concentrations of morphine. Clin Pharmacokinet 1982;;7:266-279.
21 +
Tamsen A, Sakurada T, Wahlstrom A, et al:  Postoperative demand for analgesics in relation to individual levels of endorphins and substance P in cerebrospinal fluid. Pain 1982;;13:171-183.
22 +
Bennett RL, Baumann T, Batenhorst RL, et al:  Morphine titration in postoperative laparotomy patients using patient-controlled analgesia. Curr Ther Res 1982;;32:45-52.
23 +
Bennett RL, Battenhorst RL, Graves D, et al:  Patient-controlled analgesia: A new concept of postoperative relief. Ann Surg 1982;;195:700-705.
24 +
Bennett RL, Batenhorst RL, Graves D, et al:  Variation in postoperative analgesic requirements in the morbidly obese following gastric bypass surgery. Pharmacotherapy 1982;;2:43-49.
25 +
Bennett RL, Batenhorst RL, Foster TS, et al:  Postoperative pulmonary function with patient-controlled analgesia. Anesth Analg 1982;;6:171.
26 +
Bennett RL, Batenhorst RL, Graves D, et al:  Drug use pattern in patient-controlled analgesia, abstracted. Anesthesiology 1982;;57:210.
27 +
Atwell JR, Flanigan RC, Bennett RL, et al:  The efficacy of patient-controlled analgesia in patients recovering from flank incisions. J Urol 1984;;132:701-703.
28 +
Bennett RL, Griffen WO:  Effect of patient-controlled analgesia on nocturnal sleep and spontaneous activity following laparotomy, abstracted. Anesthesiology 1984;;61:205.
29 +
Ellis R, Haines D, Shah R, et al:  Pain relief after abdominal surgery: Comparison of i.m. morphine, sublingual buprenorphine, and self-administered i.v. pethidine. Br J Anaesth 1982;;54:421-428.
30 +
Welchew EA:  On-demand analgesia: A double-blind comparison of on-demand intravenous fentanyl with regular intramuscular morphine. Anaesthesia 1983;;38:19-25.
31 +
Bromage PR, Camporesi E, Chestnut D:  Epidural narcotics for postoperative analgesia. Anesth Analg 1980;;59:473-480.
32 +
Rosen MA, Hughes SC, Shnider SM, et al:  Epidural morphine for the relief of postoperative pain after cesarean delivery. Anesth Analg 1983;;62:666-672.
33 +
Rawal N, Sjostrand U, Christoffersson E, et al:  Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese. Anesth Analg 1984;;63:583-592.
34 +
Donadoni R, Rolly G, Noorduin H, et al:  Epidural sufentanil for postoperative pain relief. Anaesthesia 1985;;40:634-638.
35 +
Stapleton JV, Austin KL, Mather LE:  A pharmacokinetic approach to postoperative pain: Continuous infusion of pethidine. Anaesth Intensive Care 1979;;7:25-32.
36 +
Church JJ:  Continuous narcotic infusion for relief of postoperative pain. Br Med J 1979;;1:977-979.
37 +
Rutter PC, Murphy F, Dudley HAF:  Morphine-controlled trial of different methods of administration for postoperative pain relief. Br Med J 1980;;1:12-13.
38 +
Nimmo WS, Todd JG:  Fentanyl by constant rate I.V infusion for postoperative analgesia. Br J Anaesth 1985;;57:250-254.
39 +
Marshall H, Porteous C, McMillan I, et al:  Relief of pain by infusion of morphine after operation—Does tolerance develop? Br Med J 1985;;291:19-21.
40 +
Cashman JN, Jones RM, Foster JMG, et al:  Comparison of infusions of morphine and lysine acetyl salicylate for the relief of pain after surgery. Br J Anaesth 1985;;57:255-258.
41 +
Sebel PS, Barrett CW, Kirk CJ:  Transcutaneous absorption of fentanyl and sufentanil in man. Br J Anaesth 1986;;58:811P-812P.
42 +
Shealy CN:  Transcutaneous electrical stimulation for control of pain. Clin Neurosurg 1974;;21:269-277.
43 +
Ali J, Yaffe C, Serrette C:  The effect of transcutaneous nerve stimulation on postoperative pain and pulmonary function. Surgery 1981;;89:507-512.
44 +
Rooney S-M, Jain S, Goldiner PL:  Effect of transcutaneous nerve stimulation on postoperative pain after thoracotomy. Anesth Analg 1983;;62:1010-1012.
45 +
Lim AT, Edis G, Kranz H, et al:  Postoperative pain control: Contribution of psychological factors and transcutaneous electrical stimulation. Pain 1983;;17:179-188.
46 +
Chrubasik J, Wiemers K:  Continuous-plus-on-demand epidural infusion of morphine for postoperative pain relief by means of a small, externally worn infusion device. Anesthesiology 1985;;62:263-267.
47 +
Shah MV, Jones DI, Rosen M:  'Patient demand' postoperative analgesia with buprenorphine: Comparison between sublingual and i.m. administration. Br J Anaesth 1986;;58:508-511.
48 +
Urquhart ML, Klapp K, White PF:  Intravenous versus subcutaneous hydromorphone for patient-controlled analgesia, abstracted. Anesthesiology 1987;;67:A231.
49 +
White PF:  Patient-controlled analgesia: A new approach to the management of postoperative pain. Semin Anesthes 1985;;4:255-266.
50 +
Tan S, White PF, Cohen SE:  Sufentanil for post-cesarean analgesia: Epidural versus intravenous administration, abstracted. Anesthesiology 1986;;65:398.
51 +
White PF:  Use of a patient-controlled analgesia infuser for the management of postoperative pain , in Harmer, Rosen and Vickers (eds): Patient-Controlled Analgesia . London, Blackwell Scientific Publications, 1985;, pp 140-148.
52 +
Vaughn L, White PF: Management of postoperative pain—PCA versus IM therapy, abstracted. Read before the Sixth Biennial General Scientific Meeting of the Association of Surgeons, Bangkok, Thailand, 1987.
53 +
Rosenberg PH, Heino A, Scheinin B:  Comparison of intramuscular analgesia, intercostal block, epidural morphine, and on-demand iv fentanyl in the control of pain after upper abdominal surgery. Acta Anaesthesiol Scand 1984;;28:603-607.
54 +
White PF:  Mishaps with patient-controlled analgesia (PCA). Anesthesiology 1987;;66:81-83.
55 +
Weis OF, Sriwatanakul K, Alloza JL, et al:  Attitudes of patients, housestaff, and nurses toward postoperative analgesic care. Anesth Analg 1983;;62:70-74.
56 +
Papper EM, Brodie BB, Rovenstine EA:  Postoperative pain: Its use in the comparative evaluation of analgesics. Surgery 1952;;32:107-109.
57 +
Egbert LD, Battit GE, Welch CE, et al:  Reduction of posterative pain by encouragement and instruction of patients: A study of doctor-patient rapport. N Engl J Med 1964;;270:825-827.
58 +
Graves DA, Foster TS, Batenhorst RL, et al:  Patient-controlled analgesia. Ann Intern Med 1983;;99:360-366.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Sechzer PH:  Objective measurement of pain. Anesthesiology 1968;;29:209-210.
2 +
Forrest WH Jr, Smethurst PWR, Kienitz ME:  Self-administration of intravenous analgesics. Anesthesiology 1970;;33:363-365.
3 +
Sechzer PH:  Studies in pain with analgesic demand system. Anesth Analg 1971;;50:1-10.
4 +
Keeri-Szanto M:  Apparatus for demand analgesia. Can Anaesth Soc J 1971;;18:581-582.
5 +
Keeri-Szanto M, Heaman S:  Postoperative demand analgesia. Surg Gynecol Obstet 1972;;134:647-651.
6 +
Finley RJ, Keeri-Szanto M, Boyd D:  New analgesic agents and techniques shorten postoperative hospital stay. Pain 1984;;2:S397.
7 +
Evans JM, MacCarthy J, Rosen M, et al:  Apparatus for patient-controlled administration of intravenous narcotics during labour. Lancet 1976;; 1:17-18.
8 +
Bahar M, Rosen M, Vickers MD:  Self-administered nalbuphine, morphine and pethidine: Comparison by intravenous route following cholecystectomy. Anaesthesia 1985;;40:529-532.
9 +
Sprigge JS, Otton PE:  Nalbuphine versus meperidine for postoperative analgesia: A double-blind comparison using the patient-controlled analgesic technique. Can Anaesth Soc J 1983;;30:517-521.
10 +
Hull CJ, Sibbald A, Johnson MK:  Demand analgesia for postoperative pain. Br J Anaesth 1979;;51:570-571.
11 +
Hull CJ, Sibbald A:  Control of postoperative pain by interactive demand analgesia. Br J Anaesth 1981;;53:385-391.
12 +
White DC, Pearce DJ, Norman J:  Postoperative analgesia: A comparison of intravenous on-demand fentanyl with epidural bupivacaine. Br Med J 1979;;2:166-167.
13 +
Kay B:  Postoperative pain relief: Use of an on-demand analgesia computer (ODAC) and a comparison of the rate of use of fentanyl and alfentanil. Anaesthesia 1981;;36:949-951.
14 +
Welchew EA, Hosking J:  Patient-controlled postoperative analgesia with alfentanil: Adaptive, on-demand intravenous alfentanil or pethidine compared double-blind for postoperative pain. Anaesthesia 1985;;40:1172-1177.
15 +
Lehmann KA, Gördes B, Hoeckle W:  Postoperative on-demand analgesia with morphine. Anaesthesist 1985;;34:494-501.
16 +
Lehmann KA, Jung C, Hoeckle W:  Tramadol und Pethidin zur post-operativen Schmerztherapie: Eine randomisierte Doppelblindstudie unter den Bedingungen der intravenösen On-Demand Analgesie. Schmerz 1985;;3:88-100.
17 +
Tamsen A, Hartvig P, Dahlstrom B, et al:  Patient-controlled analgesia therapy in the early postoperative period. Acta Anaesthesiol Scand 1979;;5:462-470.
18 +
Tamsen A, Hartvig P, Fagerlund C, et al:  Patient-controlled analgesic therapy: Clinical experience. Acta Anaesthesiol Scand 1982;;74:157-160.
19 +
Tamsen A, Hartvig P, Fagerlund C, et al:  Patient-controlled analgesic therapy: Pharmacokinetics of pethidine in the pre- and postoperative periods. Clin Pharmacokinet 1982;;7:149-163.
20 +
Dahlstrom B, Tamsen A, Paalzow L, et al:  Patient-controlled analgesic therapy: Pharmacokinetics and analgesic plasma concentrations of morphine. Clin Pharmacokinet 1982;;7:266-279.
21 +
Tamsen A, Sakurada T, Wahlstrom A, et al:  Postoperative demand for analgesics in relation to individual levels of endorphins and substance P in cerebrospinal fluid. Pain 1982;;13:171-183.
22 +
Bennett RL, Baumann T, Batenhorst RL, et al:  Morphine titration in postoperative laparotomy patients using patient-controlled analgesia. Curr Ther Res 1982;;32:45-52.
23 +
Bennett RL, Battenhorst RL, Graves D, et al:  Patient-controlled analgesia: A new concept of postoperative relief. Ann Surg 1982;;195:700-705.
24 +
Bennett RL, Batenhorst RL, Graves D, et al:  Variation in postoperative analgesic requirements in the morbidly obese following gastric bypass surgery. Pharmacotherapy 1982;;2:43-49.
25 +
Bennett RL, Batenhorst RL, Foster TS, et al:  Postoperative pulmonary function with patient-controlled analgesia. Anesth Analg 1982;;6:171.
26 +
Bennett RL, Batenhorst RL, Graves D, et al:  Drug use pattern in patient-controlled analgesia, abstracted. Anesthesiology 1982;;57:210.
27 +
Atwell JR, Flanigan RC, Bennett RL, et al:  The efficacy of patient-controlled analgesia in patients recovering from flank incisions. J Urol 1984;;132:701-703.
28 +
Bennett RL, Griffen WO:  Effect of patient-controlled analgesia on nocturnal sleep and spontaneous activity following laparotomy, abstracted. Anesthesiology 1984;;61:205.
29 +
Ellis R, Haines D, Shah R, et al:  Pain relief after abdominal surgery: Comparison of i.m. morphine, sublingual buprenorphine, and self-administered i.v. pethidine. Br J Anaesth 1982;;54:421-428.
30 +
Welchew EA:  On-demand analgesia: A double-blind comparison of on-demand intravenous fentanyl with regular intramuscular morphine. Anaesthesia 1983;;38:19-25.
31 +
Bromage PR, Camporesi E, Chestnut D:  Epidural narcotics for postoperative analgesia. Anesth Analg 1980;;59:473-480.
32 +
Rosen MA, Hughes SC, Shnider SM, et al:  Epidural morphine for the relief of postoperative pain after cesarean delivery. Anesth Analg 1983;;62:666-672.
33 +
Rawal N, Sjostrand U, Christoffersson E, et al:  Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese. Anesth Analg 1984;;63:583-592.
34 +
Donadoni R, Rolly G, Noorduin H, et al:  Epidural sufentanil for postoperative pain relief. Anaesthesia 1985;;40:634-638.
35 +
Stapleton JV, Austin KL, Mather LE:  A pharmacokinetic approach to postoperative pain: Continuous infusion of pethidine. Anaesth Intensive Care 1979;;7:25-32.
36 +
Church JJ:  Continuous narcotic infusion for relief of postoperative pain. Br Med J 1979;;1:977-979.
37 +
Rutter PC, Murphy F, Dudley HAF:  Morphine-controlled trial of different methods of administration for postoperative pain relief. Br Med J 1980;;1:12-13.
38 +
Nimmo WS, Todd JG:  Fentanyl by constant rate I.V infusion for postoperative analgesia. Br J Anaesth 1985;;57:250-254.
39 +
Marshall H, Porteous C, McMillan I, et al:  Relief of pain by infusion of morphine after operation—Does tolerance develop? Br Med J 1985;;291:19-21.
40 +
Cashman JN, Jones RM, Foster JMG, et al:  Comparison of infusions of morphine and lysine acetyl salicylate for the relief of pain after surgery. Br J Anaesth 1985;;57:255-258.
41 +
Sebel PS, Barrett CW, Kirk CJ:  Transcutaneous absorption of fentanyl and sufentanil in man. Br J Anaesth 1986;;58:811P-812P.
42 +
Shealy CN:  Transcutaneous electrical stimulation for control of pain. Clin Neurosurg 1974;;21:269-277.
43 +
Ali J, Yaffe C, Serrette C:  The effect of transcutaneous nerve stimulation on postoperative pain and pulmonary function. Surgery 1981;;89:507-512.
44 +
Rooney S-M, Jain S, Goldiner PL:  Effect of transcutaneous nerve stimulation on postoperative pain after thoracotomy. Anesth Analg 1983;;62:1010-1012.
45 +
Lim AT, Edis G, Kranz H, et al:  Postoperative pain control: Contribution of psychological factors and transcutaneous electrical stimulation. Pain 1983;;17:179-188.
46 +
Chrubasik J, Wiemers K:  Continuous-plus-on-demand epidural infusion of morphine for postoperative pain relief by means of a small, externally worn infusion device. Anesthesiology 1985;;62:263-267.
47 +
Shah MV, Jones DI, Rosen M:  'Patient demand' postoperative analgesia with buprenorphine: Comparison between sublingual and i.m. administration. Br J Anaesth 1986;;58:508-511.
48 +
Urquhart ML, Klapp K, White PF:  Intravenous versus subcutaneous hydromorphone for patient-controlled analgesia, abstracted. Anesthesiology 1987;;67:A231.
49 +
White PF:  Patient-controlled analgesia: A new approach to the management of postoperative pain. Semin Anesthes 1985;;4:255-266.
50 +
Tan S, White PF, Cohen SE:  Sufentanil for post-cesarean analgesia: Epidural versus intravenous administration, abstracted. Anesthesiology 1986;;65:398.
51 +
White PF:  Use of a patient-controlled analgesia infuser for the management of postoperative pain , in Harmer, Rosen and Vickers (eds): Patient-Controlled Analgesia . London, Blackwell Scientific Publications, 1985;, pp 140-148.
52 +
Vaughn L, White PF: Management of postoperative pain—PCA versus IM therapy, abstracted. Read before the Sixth Biennial General Scientific Meeting of the Association of Surgeons, Bangkok, Thailand, 1987.
53 +
Rosenberg PH, Heino A, Scheinin B:  Comparison of intramuscular analgesia, intercostal block, epidural morphine, and on-demand iv fentanyl in the control of pain after upper abdominal surgery. Acta Anaesthesiol Scand 1984;;28:603-607.
54 +
White PF:  Mishaps with patient-controlled analgesia (PCA). Anesthesiology 1987;;66:81-83.
55 +
Weis OF, Sriwatanakul K, Alloza JL, et al:  Attitudes of patients, housestaff, and nurses toward postoperative analgesic care. Anesth Analg 1983;;62:70-74.
56 +
Papper EM, Brodie BB, Rovenstine EA:  Postoperative pain: Its use in the comparative evaluation of analgesics. Surgery 1952;;32:107-109.
57 +
Egbert LD, Battit GE, Welch CE, et al:  Reduction of posterative pain by encouragement and instruction of patients: A study of doctor-patient rapport. N Engl J Med 1964;;270:825-827.
58 +
Graves DA, Foster TS, Batenhorst RL, et al:  Patient-controlled analgesia. Ann Intern Med 1983;;99:360-366.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems