A computer limits the number of allowable doses to prevent overdose. PCA delivers small frequent doses of pain medication minimizing the peaks and valleys in analgesia levels. Patients prefer PCA because it reduces the anxiety many feel about getting their pain medication on time and they appreciate the ability to control their own pain medication. Patients on PCA are more alert and responsive, the cough reflex is less suppressed which allows patient to clear their lungs more effectively, patients become ambulatory sooner and progress to physical therapy and rehabilitation. Also patients on IV PCA tend to use less narcotic to achieve comfort than those receiving IM injections.
Epidural analgesia is the most effective method of postoperative pain management.
Patients receiving epidural analgesia are more alert, have fewer side effects, better pulmonary function, are extubated earlier, spend less time on a ventilator, ambulate earlier, use significantly less narcotic, and have shorter ICU and hospital stays. Studies suggest that postoperative epidural analgesia is associated with reduced postoperative cardiac complications in high-risk patients. Epidural infusions of local anesthetics improve blood flow to the lower portion of the body and significantly reduce the risk of developing abnormal clotting and phlebitis in the legs after surgery. Administration of epidural local anesthetics also shorten the time for recovery of bowel function after abdominal surgery. Most health care insurance plans, including Medicare, provide reimbursement for the Acute Pain Management Service.