Intravenous Patient-Controlled Analgesia (IV PCA)

What is pain?

Pain is an uncomfortable feeling that tells you something may be wrong in your body. When there is an injury to your body or if you have a painful disease or condition, tiny cells send pain messages along nerves into your spinal cord and then up to your brain. Pain medicine blocks or lessens these messages.

How does pain affect the body?

Pain is your body's way of sending a warning to your brain. Unrelieved pain can be harmful, especially when you are sick or after surgery. Pain can make it difficult to take a deep breath and interferes with your ability to move and walk. This can result in complications and a longer stay in the hospital. Effective pain management is a very important part of treatment.

What is IV PCA?

IV PCA is just what it sounds like. The patient controls the administration of intravenous pain medication. A special pump is programmed by the nursing staff to give you an amount of pain medicine that is typically safe for someone your gender, size, age, and diagnosis or type of surgery.

How does IV PCA work?

The PCA pump used at Carl R. Darnall Army Medical Center (CRDAMC) can be programmed in three ways:

  • "PCA" mode: You will be given a button that is attached to the PCA pump. You can press this PCA button to give yourself a dose of pain medicine when you hurt.
  • "Continuous" mode: The pump will be programmed to give you a small amount of pain medicine continuously.
  • The "PCA plus continuous" mode combines the two previous options.

If you have just had surgery, the recovery room nurse will manage your pain for you when you arrive in the recovery room, then give you the PCA button as soon as you are awake enough to manage the pain yourself.

Please remember that it is more difficult to treat pain when it is severe so it is important to "stay on top" of your pain. When you begin to feel some discomfort, press the PCA button. If your pain is not relieved, please let your nurse know. The doctors and nurses rely on your reports of pain to effectively manage your pain.

What are some of the goals of pain management with IV PCA?

There are three very important goals of IV PCA:

  • To keep pain from becoming severe and out of control.
  • To keep you comfortable so you can sleep, deep breathe, walk, and visit with others.
  • To decrease the length of time spent in the hospital.

How will my doctors and nurses know how much pain I have?

Your nurses will check with you often while you are receiving IV PCA. They will ask you to rate your pain on a scale of 0-10 with 0 meaning no pain and 10 meaning the worst possible pain. Your nurses will have something for you to look at to help you "rate" your pain. Reporting your pain as a number or as a face will help the nurses and doctors know how well your treatment is working and whether or not changes need to be made.

Wong-Baker FACES Pain Rating Scale
Wong-Baker FACES Pain Rating Scale
From Wong, DL, Hockenberry-Eaton M, Wilson D, Winkelstein ML, Ahmann E, DiVito-Thomas PA: Whaley and Wong's Nursing Care of Infants and Children, ed. 6, St. Louis, 1999, Mosby, p. 1153. Copyrighted by Mosby-Year Book, Inc. Reprinted by permission.

Your nurse may ask you what your "comfort goal" is. This is the number that will allow you to be comfortable and to actively participate in your recovery. At your comfort goal you should be able to turn in bed, cough, deep breathe, walk, and participate in any rehabilitation your physician has planned for you.

Is IV PCA safe?

Yes, IV PCA is safe. The pump will be programmed with a safe hourly limit and safe time between self-administered doses so you cannot give yourself too much pain medicine too often.

Because you are the only person who will know when you are hurting and when it is necessary and safe to have a dose of pain medication, you are the only person who should press the PCA button. Your nurse, doctor, or family members may remind you from time to time to push the PCA button before activities that might cause you pain, but they should not press the PCA button.

What medications are used in IV PCA?

At CRDAMC, the physicians generally prescribe either morphine or demerol in IV PCA. Both of these medications are opioids (narcotics).

What are the side effects of IV PCA?

The side effects you may experience are the side effects associated with the pain medication.

  • Itching is not an allergic reaction but it is a fairly common side effect of pain medication. Ask your nurse for medicine to relieve the itching.
  • Nausea can occur because of pain medication. This can also be relieved by medication that has been prescribed.
  • Pain medication slows the bowel and may cause constipation. If your condition allows, the nurse may give you medicine to prevent or reduce constipation.
  • Some patients have difficulty urinating when taking pain medicine. Reducing the dose of pain medicine helps relieve this side effect, and it usually resolves on its own within 48 hours.
  • Excessive drowsiness and respiratory depression are the most serious but least common side effects of pain medicine. These two side effects develop slowly. Nurses will be checking your sedation level and breathing frequently. If detected, both are easily treated and corrected by decreasing the dose of pain medicine.

How long will IV PCA be used?

As your condition improves, your pain will decrease. You will find that you need to press the PCA button less frequently. If at this time you are able to eat and drink your physician may discontinue the IV PCA and start you on oral pain medication.

How can I manage my pain at home?

When it comes to effective pain management, the tips you learned at the hospital will also work at home.

  • Use your medication only as directed. If the pain is not relieved or if it gets worse, call your doctor.
  • Remember that oral pain medications need time to work. Most oral pain relievers need at least 20 minutes to begin to take effect.
  • Try to time your medication so that you take it before beginning an activity.
  • Pain relievers can cause constipation. If you don't have a bowel movement in two days please contact your physician. Remember to drink plenty of fluids.
  • Some pain medications can cause drowsiness. Avoid driving or other activities that require alertness when taking narcotic pain medications.
  • Do not drink any alcoholic beverages when you are taking narcotic pain medication.

Adapted from McCaffery M, Pasero C: Pain: Clinical Manual, p. 292, 1999, Mosby, Inc.

page last modified on: 3/27/2017

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