Patient/Nurse controlled analgesia

What is it?

Children who have good pain control tend to make faster recovery.

Patient Controlled Analgesia (PCA) allows your child to safely give themselves strong pain relieving medicine such as morphine (an opioid) via a special machine attached to a drip. They will be able to safely give a pain relieving drug when they need it, without delay or the pain of an injection.

Nurse Controlled Analgesia (NCA) allows the nurse to safely give your child strong pain relieving medicine such as morphine using the same special machine via a drip. It uses the same method as the PCA but is used for children who are physically unable or too young to use the special machine.

How does it work?

The PCA/NCA machine has safety features that allow strong pain medicine to be given accurately through the drip.

• A Doctor/Anaesthetist and/or a member of the Pain Service will discuss with you and your child about pain and using a PCA or NCA. They will then write an order specific to your child.
• The machine will be set especially for your child and according to the doctor's order.
• The machine has a special button on it, when pressed a dose of the pain relieving medicine will be given through the drip. This is called a 'bolus'.
• The machine may also be set so a constant small amount of the pain relieving medicine is given all the time as well as the doses given when the button is pressed. This is called the 'background'
• If it is a PCA your child can press the button when they have pain or just before painful procedures, such as a change of dressing or physiotherapy, as the pain relieving medicine takes several minutes to have its best effect.
• If it is a NCA the nurse will be able to press the button when your child has pain or just before painful procedures, just like the PCA.

How is it safe?

There are many safety features in the PCA/NCA machine and in the way the medicine is ordered.

• When the button is pressed and a dose of pain relieving medicine is given the machine will not be able to give another dose for a set amount of time (usually 5-15 minutes). This is called the 'lock-out period' and is set according to the doctor's order. This allows the pain relieving medicine to work which may take between 5-15 minutes for the best effect.
• If it is a PCA only the child is allowed to press the button.
• If it is a NCA only the nurse is allowed to press the button.
• The button is made so it is difficult for any accidental presses to happen.
• The machine is very accurate and has safety alarms to make sure it works properly and your child gets the right amount of medicine.
• Your child will be checked every hour. The nurse will check your child's level of pain, their breathing, their heart rate, how sleepy they are and sometimes their blood pressure.
• You play an important part in caring for your child as you know your child best and can assist in measuring your child's pain at and between these checks.
• Each day a member of the Acute Pain Service will review your child and make any necessary changes.

If your child is asleep, it usually means your child's pain is controlled.

If your child's pain persists, the Acute Pain Service or Anaesthetic Doctor will review your child, and make changes to relieve their pain.

Other pain relievers such as panadol (paracetamol) or nurofen (ibuprofen) may be used in conjunction with the PCA/NCA.

Why can only a child or nurse press the button?

This is a key safety measure to the PCA and NCA order.

When a PCA is being used your child is the only person who can press the button to receive a dose of the pain relieving medicine. The machine's 'lock-out period' allows the medicine to work before your child can receive another dose that may not be needed. If your child does continue to press the button when they don't have pain they might become sleepy and stop pressing. This then allows the medicine to wear off before they get too much and they will become awake again.

When a NCA is being used your child's nurse will need to carefully assess your child's pain level and their breathing, heart rate and sleepiness before they will press the button. The machine's 'lock-out period' is often set for a little longer (10 - 15 minutes) to allow the pain medicine to work fully before your child's nurse can give another bolus dose of pain relieving medicine. Your child's nurse will balance the needs of your child and the potential side-effects of the pain relieving medicine.

Are there any side effects?

The most common side effect of opioids (the common type of medication used in a PCA or NCA) is nausea and vomiting. The doctors and nurses are able to give other medicines to help with this and still provide important pain relief.

Constipation (difficulty and/or pain passing a bowel motion) can also occur due to the opioid. Medicine may be given to prevent this.

Sometimes opioids can cause itching, which can be managed by medicine or by changing the type of medicine in the PCA or NCA.

Some children will complain of a dry mouth, this will disappear when the PCA or NCA is stopped.

Opioids can make your child feel a little drowsy, but if your child is asleep, it usually means your child's pain is controlled. Your child will need and want to sleep more to help them get better as well.

Opioids can affect breathing, but the effect depends on the amount of the opioids given. Some children with severe snoring or sleep apnoea will be closely monitored and may need extra oxygen while on a PCA or NCA.

A few children may show some mild behaviour and thinking changes. This will disappear when the PCA or NCA is stopped.

Will my child get addicted to an opioid?

Children do not become addicted to pain relieving medicine as it is being given to relieve pain from an operation or sickness. If the PCA or NCA is used for more than a few days your child's body may become used to the pain relieving medication, in this case the PCA or NCA needs to be reduced slowly.

Following surgery, PCA or NCA is typically used for 2 to 5 days. Remember that every child is different; some types of surgery and illness can result in more pain.

Your child may need pain relieving medicines that can be given by mouth after the PCA or NCA is stopped which your doctor will explain to you.

• You know your child best and we rely on that knowledge.
• If at any time you are concerned about your child, please tell a nurse or doctor.
• There will always be someone around to answer any questions or worries that you might have.