Patient-controlled oral analgesia: a low-tech solution in a high-tech world

The primary concern of surgical patients is the expected experience of pain. Presently, the standard for acute postoperative pain management is intravenous patient-controlled analgesia (PCA). Many authors have reported that patients prefer intravenous PCA to nurse-administered analgesia because it affords them greater control and optimizes their pain relief. However, when the patient strengthens and is able to resume enteral sustenance, intravenous PCA is routinely discontinued and replaced with nurse-administered oral analgesia. This eliminates much of the patients' control over managing their pain and results in patients waiting, in pain, for a nurse to bring their pain tablets. When PCA is administered in the hospital setting, it is most often administered by intravenous, subcutaneous, or epidural routes. This article describes the implementation of a successful inpatient program that offers patient-controlled oral analgesia (PCOA). Patient-centered care is "an approach that consciously adopts the patient's perspective...about what matters." Patient-centered care is the practice philosophy of the University Health Network, a large tri-site teaching hospital in downtown Toronto, Ontario, Canada, affiliated with the University of Toronto. This philosophy underpins the concept of PCOA as it has been successfully operationalized in a unique PCOA program at the Toronto Western Hospital, one of the three sites comprising the University Health Network.