‫كلية بالد الرافدين الجامعة‬

‫قسم التخدير‬
‫المرحلة الثالثة‬

‫‪anesthetic equipment‬‬
‫)‪patient controlled analgesia (PCA‬‬
‫تقنيات اجهزة التخدير‬

‫اعداد‪ :‬م‪ .‬م‪ .‬عمار حوم‬

Patient controlled analgesia (PCA)
PCA represents one of the most significant
advances in the treatment of postoperative pain.
Improved technology enables pumps to accurately
deliver boluses of opioid when a demand button is
activated by the patient. It is the patient who
determines the plasma concentration of the opioid,
this being a balance between the dose required to
control the pain and that which causes side-
effects. The plasma concentration of the opioid is
maintained at a relatively constant level with the
dose requirements being generally smaller.
Components

1. A pump with an accuracy of at least 15% of

the programmed dose.

2. The remote demand button connected to

the pump and activated by the patient.

3. An anti-siphon and backflow valve.

Mechanism of action
1. Different modes of analgesic administration can be
employed:
a) patient controlled on-demand bolus administration (PCA)
b) continuous background infusion and patient controlled
bolus administration.
2. The initial programming of the pump must be tailored for
the individual patient. The mode of administration, the
amount of analgesic administered per bolus, the lock-out
time (i.e. the time period during which the patient is
prevented from receiving another bolus despite activating the
demand button), the duration of the administration of the
bolus and the maximum amount of analgesic permitted
per unit time are all variable settings on a PCA device.
3. Some designs have the capability to be used
as a PCA pump for a particular variable duration
then switching automatically to a continuous
infusion as programmed.
4. The history of the drug administration including
the total dose of the analgesic, the number of
boluses and the number of successful and failed
attempts can be displayed.
5. The devices have memory capabilities so they
retain their programming during syringe changing.
6. Tamper-resistant features are included.
7. Some designs have a safety measure where an
accidental triggering of the device is usually prevented
by the need for the patient to make two successive
presses on the hand control within 1 second.
8. PCA devices operate on mains or battery.
9. Different routes of administration can be used for
PCA, e.g, intravenous, intramuscular, subcutaneous or
epidural routes.
10. Alarms are included for malfunction, occlusion and
disconnection.
11. Ambulatory PCA pumps are available allowing
patient's mobilization during use.
Problems in practice and safety features
1. The ability of the patient to co-operate and
understand is essential.
2. Availability of trained staff to programme the
device and monitor the patient is vital.
3. In the PCA mode, the patient may awaken in
severe pain because no boluses were
administered during sleep.
4. Some PCA devices require special giving
sets and syringes
5. Technical errors can be fatal.
Thank you