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Patient-Controlled Analgesia (PCA)

What is patient-controlled analgesia?

Patient-controlled analgesia (PCA) is a method of pain relief. Patients can decide when to get a dose of pain medicine based on a prescription. They do this by pressing a button on a PCA pump. 

Only the patient should push the pump’s button. A parent should push the button only if a doctor or nurse has said it is OK. The doctor or nurse will tell you when you should and should not push the button.

Patient-controlled analgesia (PCA)

A pain relief method in which patients control the amount of medicine. Patients receive a preset dose by pressing a button on a pump that is connected to a small tube in the body.

How a PCA pump works

Your child’s care team decides the pain medicine to give through the PCA pump. A tube from the pump is attached to the child’s IV line. The pain medicine may be morphine, hydromorphone (Dilaudid®), fentanyl, or another medicine used to manage pain.

When your child presses the button, the pump gives a set amount of medicine through the IV line. This dose is called a “bolus dose” or “boost.” Your child can have smaller doses more often by pushing the button. This reduces the risk of your child becoming too sleepy and slowing their breathing rate.

Overdose protection

The pump’s timer prevents the patient from giving doses more often than prescribed. If the patient pushes the button too early, the pump will not give the dose. The pump will give a dose only if enough time has passed since the last dose.

Do not change the pump settings or give any dose other than the programmed dose. Only health care providers may change the pump settings.

Some people worry about becoming addicted to the pain medicines. The chance of becoming addicted is very rare. If your child is using these medicines only for pain, this should not become a problem. In fact, your child will need this pain relief to remain active and rest well.

Full-time pain relief

The doctor can have the pump set to give a constant amount of pain medicine even if your child does not push the button. This is called a continuous, basal, or background infusion.

The care team will review your child’s pain level and the number of times your child pushes the button. The team can decide which medicine dose is best by looking at those details. If your child still has pain, the team may increase or decrease the dose. Or they may use a different medicine.

Talk to your care team if:

  • You think your child is not getting enough pain relief.
  • You have questions about the PCA pump.

PCA for pain prevention

A patient’s pain level may differ from one day to the next or from one time of day to another. Your child may need to push the button more on certain days or at certain times of the day.

For best pain control, patients should:

  • Press the button before the pain is severe.
  • After pushing the button, wait a few minutes for the pain medicine to work.
  • Push the button before an activity that may cause pain, such as dressing changes.
  • Push the button only for pain relief – not for other reasons.

Side effects

Check with your child’s care team before giving other medicines that may cause sleepiness. These include diphenhydramine (Benadryl®), lorazepam (Ativan®), promethazine (Phenergan®), or other anti-nausea medicines.

Sometimes medicines in the PCA pump can cause side effects. Usually, these symptoms will go away over time or by reducing the dose of pain medicine. Report the following side effects to your child’s care team as soon as possible:

More serious side effects need attention right away. If your child has the following symptoms, stop the PCA pump and call your care team:

  • Changes in your child’s ability to think
  • Confusion
  • Hallucinations (seeing things that are not there)
  • Extreme drowsiness can be a sign that the amount of pain medicine is too much. This could soon cause slow breathing.

If your child stops breathing:

  • Call 911.
  • Stop the PCA pump.
  • Gently shake your child.
  • Provide CPR if breathing does not start again.

Key points

  • Patient-controlled analgesia (PCA) is a method of pain relief that lets patients decide when to get a dose of pain medicine.
  • Only the patient should push the button on the PCA pump, unless medical staff says otherwise.
  • Check with your child’s care team before giving other medicines that may cause sleepiness.
  • Watch carefully for side effects and take action if needed.

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The Together by St. Jude™ online resource does not endorse any branded product mentioned in this article.

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Reviewed: February 2022