Patient Controlled Epidural Analgesia (PCEA)

What is pain?

Pain is an uncomfortable feeling that tells you something may be wrong with your body. After surgery, 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 the 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 patient controlled epidural analgesia (PCEA)?

Before surgery or during labor, the anesthesia care provider places an epidural catheter in your back. Pain medicine will be given through this tiny tube. A special pump will be programmed by the anesthesia care provider to give you an amount of pain medicine that is typically safe for someone your gender, size, age, and type of surgery. The amount of pain medicine given can be adjusted to achieve a satisfactory level of pain relief.

How does PCEA work?

The epidural pump used at Carl R. Darnall Army Medical Center (CRDAMC) is generally programmed by the anesthesia care providers to provide for a PCEA mode and a continuous mode.

  • "PCEA" mode: You will be given a button that is attached to the epidural pump. You can press this PCEA 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 recovery room nurse will manage your pain for you when you arrive in the recovery room, then give you the PCEA button as soon as you are awake enough to manage the pain yourself. Please remember that it is 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 PCEA 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 PCEA?

There are three very important goals of PCEA and reasons why PCEA is prescribed:

  • To keep pain from becoming severe and out of control. With PCEA, less medication is needed because it is delivered directly to the opiate receptors. This decreases the likelihood and severity of side effects.
  • To keep you comfortable so that you can sleep, deep breathe, walk, and visit with friends.
  • To decrease the length of time spent in the hospital.

How is the epidural catheter placed?

  • You will be positioned on your side or sitting up with your back arched out to the anesthesia care provider.
  • Your back will be washed with a cool soap solution.
  • The anesthesia care provider will inject local anesthetic to numb the area where the needle will go. This will feel like a sting.
  • You will feel pressure against your back while the anesthesia care provider finds the epidural space with the epidural needle.
  • A very small catheter will be inserted through the needle into the epidural space. The needle will then be removed leaving the catheter in place.

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

Your nurses will check with you often while you are receiving PCEA. 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 PCEA safe?

Yes, PCEA is safe. The pump will be programmed with a safe hourly limit and safe time between 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 PCEA button. Your nurse, doctor, or family members may remind you from time to time to push the PCEA button before activities that might cause you pain, but they should not press the PCEA button.

What medications are used in PCEA?

At CRDAMC, the anesthesiologists generally prescribe medications called fentanyl, which is an opioid, and bupivacaine, which is a local anesthetic. These medications work together to provide pain relief.

What are the side effects of PCEA?

The side effects you may experience are the side effects associated with the fentanyl and bupivacaine.

  • Itching is not an allergic reaction but it is a fairly common side effect of pain medicine. 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 in 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 and breathing frequently. If detected, both are easily treated and corrected by decreasing the dose of pain medicine.
  • Numbness and tingling from the epidural local anesthetic is normal in and around the surgery incision area. Let your nurse know if numbness or tingling occurs in other areas. If you have difficulty feeling or moving your legs do not attempt to walk. This usually can be corrected by reducing the dose of pain medicine. Be sure to ask someone to help you up the first few times you walk.

How long will PCEA be used?

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

The anesthesia care provider will remove the epidural catheter. This is a simple and painless procedure.

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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