Patient-Controlled Analgesia in High-Risk Populations: Implications for Safety
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PATIENT SAFETY IN ANESTHESIA (SJ BRULL, SECTION EDITOR)
Patient-Controlled Analgesia in High-Risk Populations: Implications for Safety Alberto Ardon 1
&
Nigel Gillespie 2 & Sree Kolli 3 & Ashley Matthews Shilling 4 & Matthew Warrick 5
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review We aim to (1) identify the benefits and risks of patient-controlled analgesia and (2) analyze the risks of using various modalities of PCA among patients with traumatic injuries, sleep apnea, chronic pain, or neuropathies. Recent Findings An oral sufentanil PCA system may be as effective as an intravenous PCA. The overall incidence of PCA device error is less than 1%. While IV PCA may not be more effective than nurse-administered opioid among trauma patients, thoracic epidural analgesia may improve outcomes. Patients with obstructive sleep apnea or obesity are at increased risk of opioid-induced respiratory depression (OIRD). Patients with chronic pain or opioid tolerance, who may require higher opioid dosing, benefit from close monitoring. Continuous pulse oximetry and capnography can improve detection of OIRD. Risk of nerve injury after nerve block may be higher among patients with peripheral neuropathy, but this risk may be decreased with lower local anesthetic total dose or concentration. Summary PCA, whether in intravenous, neuraxial, or peripheral nerve form, can have a significant role in postoperative analgesia. Regardless of technique, use of a PCA method should account for the potential risks to the patient, particularly in the presence of comorbidities such as sleep apnea, polytrauma, chronic pain, and preexisting neuropathy. Keywords Patient-controlled analgesia . Opioid . Multimodal analgesia . Respiratory depression . Trauma . Neuropathy . Pump failure
Introduction and Review of Patient-Controlled Analgesia Patient-controlled analgesia (PCA) has been present in clinical care for over two decades. PCA delivery mechanisms have included systems that provide analgesics via several routes
(intravenous, oral, transdermal, epidural, peripheral nerve) and utilizing different technologies (elastomeric pumps, programmable digital devices). The concept of PCA has been described as advantageous because it (1) empowers the patient, (2) is effective at achieving appropriate pain control, (3) usually has minor side effects, and (4) can be cost-efficient
This article is part of the Topical Collection on Patient Safety in Anesthesia * Alberto Ardon [email protected]
1
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
2
Regional Anesthesia and Acute Pain Medicine Fellow, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
3
Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
4
Department of Anesthesiology, University of Virginia Health System, PO Box 800710, Charlottesville, VA 22908, USA
5
Department of A
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