You have finished viewing your e-Prescription!
Take a Course
or
Close

{{{stage.title}}}
The Portland Hospital

Dedicated to the Healthcare needs of women, children and their families.
{{ ellipsisText }}

Pain relief leaflets

Pain relief after surgery

In Short
Pain relief after surgery using Patient Controlled Analgesia (PCA) and Nurse Controlled Analgesia (NCA)

What are PCA and NCAs?

Patient or nurse controlled analgesia (PCA or NCA) is a system that allows pain relief medication to be given as and when your child needs it. It uses a programmed syringe pump, containing a syringe of pain relieving medicine, which is given into a vein through a thin, plastic tube called a cannula. The machine has a handset with a button that can be pressed to deliver a safe dose (bolus) of pain relief. There may also be a small amount of medicine being infused into the vein continuously (called a background). PCA/NCA is used when a child is unlikely to be able to eat or drink for a few days or if the operation has been more painful so requires stronger pain relief.

When the button is pressed, a dose of the pain-relieving medicine is pushed from the syringe, through the tube and into your child’s bloodstream via the cannula. It takes between 5 and 10 minutes for the medicine to start working. The pump is programmed with safety features to avoid too much medicine being given. It ‘locks out’ for a certain length of time, so that even if the button is pushed again, no more medicine will be given. The pump is also set with the maximum amount of medicine that your child can receive. The machine itself is locked with a key so that these settings cannot be altered.

What is the difference between PCA and NCA?

If your child has a PCA, he or she is given control of the handset and can therefore decide when the pain relief is given and how much. This means that your child has control over their pain and can have pain relief without asking a nurse.

It is important that your child is the only person to press the button. This is a safety mechanism to stop your child having too much pain medicine. If your child uses too much (although it is limited to a safe amount), he or she will fall asleep so will not be able to press the button again. In order to be deemed suitable to use a PCA, your child will need to be assessed by a nurse or an anaesthetist to ensure that he or she is:

  • Old enough to understand how the pump works and what happens when the button is pushed – most eight year olds can understand this, but some younger children may be able to as well.
  • Able to understand when to use the button and for what type of pain.
  • Physically able to push the button.

If your child is not suitable for a PCA, we will set them up with a NCA. This is similar to the PCA but is adapted for younger children and those unable to press the button. The nurse will press the button after assessing your child’s pain and check to make sure he or she is not too sleepy. It is important that the nurse is the only person to press the button.

Some children start with a NCA and switch to a PCA when they are starting to wake up and recover from the surgery.

What medicines are used in PCA and NCA?

The pain relief medicine used most often is Morphine, which is a strong and effective analgesic. The amount of Morphine given to your child is carefully calculated according to their age and weight. Morphine is not addictive when given for pain relief. However, children who are on high doses of Morphine for more than a week may find that their bodies become used to its effect. When the Morphine is no longer required, this can easily be managed by gradually reducing the dose over a few days. This should not delay your child’s discharge from hospital or cause any long term problems. As well as Morphine from the PCA/NCA, your child will also receive regular Paracetamol and possibly a non-steroidal anti-inflammatory drug (NSAID), such as Ibuprofen or Diclofenac, if suitable for your child.

What are the benefits of using PCA/NCA?

The PCA/NCA dose can be given to your child based on their needs.

It can be given even if your child is not able to eat or drink.

With a PCA, older children may feel they have some control over their pain and be able to balance their pain relief with side effects.

Patients can titrate their analgesia to their level of pain.

It provides a rapid response to the demand for analgesia.

There are fewer complications when certain pain-relieving agents are administered via PCA/ NCA.

Side-effects of PCA/NCA

Sometimes the Morphine in the PCA/NCA can cause your child to become too sleepy and it may also slow their breathing rate. The nurses on the ward will monitor your child closely for these signs. All children having PCA/NCA are prescribed another medicine that can reverse this effect very quickly.

Morphine can sometimes make your child feel sick, itchy or constipated. Reducing the dose can be helpful or other medicines can be prescribed to stop these side effects.

While your child is using the PCA/NCA the nurses will carry out hourly assessments of his or her pain, level of sedation (sleepiness) and any side effects.

Any questions

If you have any questions about your child’s pain, please ask our nurses on the ward, your child’s Anaesthetist, Pharmacist, RMO or the PSP – Ext 10843/10969

Please also contact – Nasra Ahmed, Complex Surgical/Pain Lead Nurse: Tel Tel: 020 7580 4400 (ext 10838)

DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.