New Age PostOp Pain Control – Moving from PCA to PCRA

When I was training as surgeon, the mainstay of post op pain control was the PCA (Patient Controlled Analgesia). Considered “State of the Art” at the time, a PCA is a small pump that will deliver a small quantity of morphine through a drip when the patient pushed a button (hence “Patient Controlled”).

These devices worked quite well for pain control but have a number of drawbacks:
(1) Morphine is an excellent pain killer but has numerous side effects – nausea, constipation, drowsiness and respiratory depression being some of the more common. A patient who is nauseous or severely constipated is often in no shape to participate in physio, function independently or achieve an early post op discharge;
(2) PCA devices administer morphine through an IV cannula and drip. Patients are consequently left attached to IV poles and cannot mobilise. Patients stuck in bed on an IV are at risk of developing clots (DVT), chest infections and are generally slow to recover.

In recent years, surgeons have appreciated the benefit of injecting local anaesthetic directly into and around the surgical site, rather than giving large dose of systemic (oral or IV) pain medication.

By delivering anaesthetic to the source of pain and blocking the transmission of pain impulses to the brain, less (or ideally no) additional pain medication is required. Fortunately a new pump called a PCRA (Patient Controlled REGIONAL Anaesthesia) has been developed.

I am a keener proponent of this technology.

The small hand-held pump delivers a small injection of local anaesthetic directly into the surgical site at the push of a button. The benefits are (i) that patients no longer require IV morphine – therefore my patients have far less nausea, sedation or constipation. (ii) Secondly, the pumps are very small and lightweight and are carried around the neck or shoulder like a small purse or handbag. They therefore do not anchor the patient to the bed and do not interfere with the patient mobilising. Patients are therefore able to participate in early physio and rehab and achieve faster recovery and faster discharge.

Feel free to get in touch to learn more about PCRA technology and how this is used in my practice to achieve excellent pain management while avoiding IV morphine or other opiate analgesia.

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