Management of patient-controlled analgesia: A comparison of primary surgeons and a dedicated pain service

Although Patient-Controlled Analgesia (PCA) is routinely available in most hospitals in the United States, there appears to be little standardization regarding who provides this valuable service to postoperative patients. This study evaluates the differences in PCA management practices and patient outcomes between primary service (PS) physicians and acute pain service (APS) physicians. Over a 3-mo period, 40 patients prescribed PCA by PS physicians were prospectively studied without the knowledge of the physicians or nurses involved in PCA management. After collecting PS data, a proportionate stratified random sampling procedure was used to select 40 APS patients matched for gender, age, and type of surgery. Data regarding patient demographics, PCA prescription, changes in PCA orders, opioid consumption, reason for discontinuation of PCA, verbal analog scale pain scores, side effects, and post-PCA pain management were analyzed. Although pain scores were not different between groups, APS patients had fewer side effects, were more likely to receive a loading dose, had their PCA settings adjusted more often (P < 0.05), and used more opioid. PS patients were more likely to receive intramuscular medications after PCA discontinuation (P < 0.05). This study demonstrates potentially important PCA management differences between APS and PS physicians.