Patient-Controlled Regional Anesthesia (PCRA)

PCRA lets your child get pain medicine when they need it. The care team puts a small, narrow tube (catheter) under the skin. This tube may be placed near a specific nerve or group of nerves (nerve block) or into the epidural space around the spine (epidural). The other end of the catheter connects to a pump that gives pain medicine. The pain medicine may be bupivacaine, ropivacaine, or another medicine.

A small, handheld device with a button is used to control the pain medicine. When the button is pressed, the pump gives a set amount of medicine through the catheter. This is sometimes called a boost dose.  

The pump can also be 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.

Benefits of PCRA 

Some possible benefits of using PCRA are: 

• Your child can control their own pain relief and get medicine when they need it. 
• The medicines are not opioids, so the side effects of opioids are avoided. 
• The medicine goes only where the pain is, not to the whole body, so there are fewer side effects. 
• Your child may be able to move around sooner and recover more quickly. 

Breakthrough pain can sometimes occur with an epidural or nerve block. If your child is old enough, the care team will ask them to use a pain scale to describe the level of pain. Let your care team know if your child continues to have pain.  

PCRA safety

PCRA is a safe way to manage pain. Your care team makes sure that the pump is set to give the correct amount of medicine and prevent overdose.

Only the patient should push the pump’s button. Your care team will go over the instructions for how and when to use the pump. A parent or caregiver should push the button only if your health care provider has said it is OK. Follow your care team’s instructions for when you should and should not push the button.

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 should change the pump settings. 

Your care team will monitor your child while they have the regional anesthesia infusion and for at least 24 hours after the catheter is removed.

Side effects of PCRA

Like any medicine, regional anesthetics may have side effects. Side effects will depend on the specific medicine used. Side effects of PCRA include:

• Numbness, tingling, or weakness in the area being treated
• Itching, tenderness, or skin irritation near the tube
• Problems urinating (peeing)
• Nausea or vomiting
• Feeling sleepy, dizzy, or drowsy
• Slowed breathing
• Headache
• Very rarely, bleeding or problems with the nerves

Some of these side effects may go away as the body adjusts to the medication. Report any new or worsening signs or symptoms to your care team.

If your child gets PCRA with an epidural or nerve block, they may have numbness or trouble moving their lower body. Work with your care team to take steps to prevent falls or injury.

Tell your care team right away if your child has any signs of an allergic reaction, such as rash, itching, or problems breathing. 

Reminders for PCRA

Follow your care team’s instructions about using the medicine pump and hand-held device. 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 often 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. 
• Check that the tubing is not pinched or kinked. 

  Questions to ask your care team

• What are the risks and side effects of using these medications?
• How long will my child use the medicine pump?
• How do I know when my child should press the pump button?
• What are other options for pain control?
• What if my child continues to have pain?