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KMID : 0858219970010030340
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Intravenous Anesthesia
1997 Volume.1 No. 3 p.340 ~ p.344
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PCA: Past, Present and Future
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Paul F. White
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Abstract
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Despite advances in our understanding of the pathophysiology of acute postoperative
pain and the pharmacology of analgesic drugs, postoperative pain is not always
effectively treated.* Since the early report on the under treatment of pain by Marks and
Sachar, there are numerous publications describing inadequate management of
postoperative pain.
It is now recognized that under treatment of postoperative pain may be due to a
number of factors related to knowledge, skills and attitudes of health care personnel,
including concerns for side effects of analgesic drugs. In addition, the inherent
pharmacokinetic and pharmacodynamic variability among patients contributes to
differences in their analgesic requirements. Furthermore, variability in the patients'
perception of pain contributes to difficulty in determining the appropriate dose of
analgesic drugs.
It has been known for many years that intramuscular (IM) opioids administered either
as needed or as scheduled injections are not optimally effective in relieving pain. It is
difficult to accurately predict individual needs for analgesics because they are governed
by a complex interplay of pharmacokinetic, pharmacodynamic, anthropometric, and
personality factors. In addition, there is a progressive decline in the need for analgesics
during the postoperative course. Individualization of analgesic therapy is crucial in
treatment of postoperative pain.
Patient-controlled analgesia (PCA) allows titration of analgesic drugs to the individual
patients' requirements and is designed to accommodate the wide range of analgesic
requirements that can be anticipated when managing postoperative pain. The use of
PCA systems in the postoperative period has become increasingly popular for
hospitalized patients over the past 15 years. The development of sophisticated
microcircuitry for electronic PCA devices, and simplified non-electronic PCA devices, as
well as a better understanding of the pharmacologic and patient characteristics
influencing the efficacy of PCA has lead to an explosion of interest in the use of PCA
as an analgesic modality for both hospitalized and ambulatory patients.
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