Please don't press that button

PCA (Patient Controlled Analgesia) is a godsend for most patients and nurses. It's a pump attached to your IV that contains your narcotic of choice (usually morphine or dilaudid), and by pressing a button whenever you need it, you are able to get a preset amount of pain med into your system.

You can order the settings in a variety of ways, from the dose of each pain med, to how often it can be administered, to a four hour maximum dose limit. This way, no matter how many times a patient pushes on the button, you only get a certain set amount, and very rarely do you see overdoses. And if you don't need any pain meds, you just don't push on the button. Simple as that.

I almost always use a PCA pump for my post-operative patients. This way, they don't have to call the nurse and wait for them to come around with pain meds. My standard setting is 1mg morphine every 8 mins, with the ability to increase to 2mg q8 mins if necessary, with 20mg to 30 mg maximum 4 hour dosage. I don't like continuous delivery settings because frankly, I don't think it's safe. Naturally I adjust accordingly to the size of the patient and other medical factors.

The system usually works beautifully. The patients are in charge of one aspect of their care, which is so important in a hospital environment where they usually feels as though they have relinquished all control of their lives. In addition, the immediate relief of the surgical pain can really help in the post-operative course. The whole concept of a PCA works when the patient is the one pushing the button whenever there is a need.

The system goes awry when well-intentioned family members want the patient to feel as comfortable as possible, and will push the PCA button for him/her, even when the patient is asleep or not in any obvious pain. The family will keep a vigil over the patient's every single facial expression, and if there is a suspicion of an involuntary grimace, or a little moan that escapes during the nap, they will press the button. Certainly well-meaning, but probably not the wisest course of action especially when the patient goes into respiratory depression and Narcan has to be administered rapidly.