PCA – A special form of postoperative pain therapy
PCA stands for “patient-controlled analgesia”. This form of therapy has been known since the 1970s. In general, it is any kind of pain therapy in which the patient can decide for himself when to receive a dose of painkillers.
This means that the patient himself determines the intervals between doses. The total dose, the maximum of a single dose and the type of medication are of course determined by doctors. As a rule, in post-operative pain therapy an opiate is administered intravenously by a so-called pain pump.
The patient can then trigger the injection by pressing a button, for example. The advantage here is that the patient can decide on his pain relief within a certain secure framework independently of doctors and nursing staff. However, there are of course also disadvantages. Patients with physical or mental limitations may not be able to trigger the button. There is also the risk of medication misuse or over- or underdosing of the medication if the pain pump is not programmed correctly.
What do the guidelines say?
The current “S3 Guideline on “Treatment of Acute Perioperative and Postoperative Pain” from 2009 was prepared in view of the still inadequate care of postoperative pain. It includes numerous studies and metastudies from previous years and is divided into a general and a specific part. The former deals with aspects such as patient education, pain measurement and documentation, and organizational aspects.
The special part of the guideline deals with the individual procedures of pain therapy as well as special aspects in the individual surgical fields. The focus is not only on systemic pain therapy with non-opioid analgesics and strong and weak opiods. Rather, the value of non-drug procedures is also covered.
Psycho- and physiotherapeutic methods, but also physical methods (e.g. cold therapy) and “transcutaneous electrical nerve stimulation” (TENS) play an important role. A benefit of acupuncture for acute pain therapy postoperatively could not be proven so far, in contrast to the treatment of chronic pain. Finally, regional anesthetic procedures in the sense of spinal cord near and peripheral regional anesthesia will be discussed.
