Patient-controlled analgesia (PCA) refers to the use of a medical device that delivers defined doses of pain medication to a patient on demand. Specific doses are programmed by a health care professional, and the device is also programmed to limit the administration of each dose or a cumulative amount of drug within certain time intervals. PCA typically involves intravenous opioid delivery, but may include other drugs (such as non-steroidal anti-inflammatory drugs or local anaesthesia) or other routes of administration (for example, subcutaneous, transdermal, pulmonary or nasal administration). It is commonly used for post-operative pain, but PCA for acute pain management in the hospital emergency department has also been studied.
It has been documented that acute pain is not adequately controlled in patients in pre-hospital emergency care settings. This observation of suboptimal pain management may extend to situations in which patients who require transfer from a rural or remote hospital to a higher level of care are in emergency vehicles for up to several hours. In some jurisdictions, ambulances are staffed by paramedics with basic life support training; doctors and nurses are not available to administer analgesics. Therefore, there is a potential role for PCA to provide sufficient acute pain management in this setting. The purpose of this report is to review the evidence of the clinical effectiveness and guidelines regarding PCA for patients with acute injury during transfer to a higher level of care.
Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.
