Anesthestic epidural and narcotic PCA vs. combo narcotic/anesthestic epidural

florry · May 18, 2004

Can someone tell me the benefit of using both a PCA for pain and and anesthestic epidural vs. the combo epidural in a postop pt (abdominal surgery)? The PCA and epidural both was effective for my patient and I was told that I was going to see more of this, but I didn't get a chance to discuss the reason why the reason for its effectiveness over the epidural alone. Thanks in advance.

Pca is a short term for patient controlled anestesia. I assume that your patient got both iv and epidural paincontroll: and you might use a PCA pump for both. The reasen they choose to use both epidural and systemic (iv) pain-controll is to get better effect. If they use epidural; often they use Marcain and morfin; but not that much so the pt. cant walk/move their legs. Often they have to use iv-painkillers too: feks. Morfin and som antiemetics and maybe some other types of medication as neuroleptics. Used together; this will optimize the painkilling effect. The PCA-pumps are small computers and the doctors have programmed the maximum dose that the pt. can push with using a button/remote-control on each, then overdose is impossible.

(Excuse my english, but I'll try to explain...) I have had many patiens with severe pain-problems (fex. after canser operations abd./pelvis) and they have had great benefits of targeting the pain from different sides: Iv, epidural, sometimes spinal, oral, subcutan (sc), dermalt (patches), sometimes its easier to controll iv, but the effect will last longer with epid. Sometimes its different types of pain: nococeptiv, neurogenic or other types: and therefor they have to use different methods. By the way: neurogenic pain is VERY hard to kill, and often it take some times until the medication against this pain will have effect, and in the meantime you choose high doses of opioids iv until the correct balance has come.

Hope this was understandable: remember that painkilling is very hard and complex in many cases!!

sharann, BSN, RN · May 18, 2004

The combo is very potent and effective in certain patient types we have noted. The first is obviously the pt who has low pain threshold, or has been a sufferer of chronice pain. The second type may overlap the first type, which is one who is TOLERANT(not addicted!) to narcotics and therfore need more agressive pain control.

That said, these pts must always go to the ICU post surgery due to the need for frequent vitals and monitoring that the regular floors cannot possibly do due to their staffing and/or acuity levels. The epidural usually is turned off after 24 hours, then the patient is weaned off PCA in 48-36 hours. Works well to have the transition without going down too quickly.

Gldngrl · May 19, 2004

Thanks for your responses. I believe that I should probably direct my question to my pain service since there may be factors influencing the decision to use both a PCA and epidural.

However, this patient is not in an ICU and is monitored q 2hr and the epidural was only delivering a local anesthestic and did so for about a week and still has a PCA (chronic pain plus surgical pain).