Abstract
We present the indications and contraindications of the patient-controlled analgesia (PCA) system and intravenous PCA (IV-PCA). PCA is contraindicated in patients who cannot comprehend PCA, refuse to use PCA, or cannot operate the PCA device. Indication of IV-PCA depends on the type of surgery, duration of postoperative pain, and the start of oral intake. In other words, patients who can understand the PCA system and require parenteral opioids for their moderate to severe pain during the first few postoperative days are good candidates for postoperative IV-PCA, even young children. Furthermore, IV-PCA is a good choice for patients who are contraindicated for postoperative epidural analgesia such as the patient refusing, deformities of the spine, abnormal coagulation status, and perioperative aggressive anti-thrombic therapy. On the other hand, adverse events related to intravenous opioids, especially respiratory depression, must always be kept in mind. Improving postoperative analgesia and also avoiding adverse events related to opioids, multimodal analgesia consisted with opioid, nonsteroidal anti-inflammatory drug and neural blockade is rational choice for postoperative analgesia.
