PCA Efficacy

One of the major benefits of PCA is that it helps overcome the wide inter-patient variation in opioid requirements by allowing each individual patient to titrate the amount of opioid they receive based on the response they experience. In addition there is some degree of a placebo effect imparted by the use of a PCA enhancing the overall pain control. The patient-controlled aspect is also one of the major safety features of the PCA in that it is assumed that if a patient is getting sedated they will not activate the PCA thereby limiting the possibility of respiratory depression.

Based on the results of several meta-analyses, when PCA is compared to conventional nurse-administered opioids on an as-needed basis, it has been shown to provide slightly better pain control, improved patient satisfaction, and is preferred by patients. Patients with a PCA use slightly more opioid and experience a higher incidence of pruritus but have similar rates of other opioid-related side effects (e.g., nausea, vomiting, sedation, and respiratory depression). There is also a slight (non-significant) reduction in the length of hospital stay in patients using PCA. Finally there appears to be a lower incidence of pulmonary complications in patients using PCA.

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