Patient-controlled analgesia (PCA) in head and neck surgery

Patients undergoing head and neck surgery often have significant pain because of the anatomic area involved, the nature of the surgery and trauma associated with the anesthesia and surgery, or the use of packing postoperatively. A patient-controlled analgesia (PCA) infuser is available that allows the patient to direct delivery of their own analgesia. The physician orders the narcotic analgesic dose to be given, the interval between doses, and the total amount of analgesic to be delivered over 4 hours. The patient simply presses a button connected to the analgesic infuser, which delivers a predetermined intravenous dose of the particular analgesic. The infuser is then "locked out" for an interval of 10 to 15 minutes before the patient can direct another dose of medicine. This system allows the patients to initiate intravenous delivery of their narcotic analgesic, and maintain control of pain, using small incremental doses of the analgesic agent. This PCA pump has been used successfully in a number of patients undergoing various general, head and neck, and facial aesthetic procedures. The general concept of the PCA pump, guidelines for use, and contraindications are presented.