Use of patient-controlled analgesia with critically ill patients: a risk/benefit analysis

Patient-controlled analgesia (PCA), a system by which patients self-administer intravenous doses of narcotics using specially programmed infusion pumps, has been used for pain management in acute care settings for nearly two decades. The safety and effectiveness of PCA has been documented in many acutely ill patient populations. Its introduction into critical care practice in the last five years has provided an important adjunct to traditional methods of pain management. However, intravenous narcotics of any type can provoke hemodynamic or respiratory complications in these compromised patients. Nursing expertise is a key factor in the successful implementation of PCA in critically ill patients.