Quote from Gldngrl
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!!