![]() Patients with chronic illnesses who are suffering from lower levels of constant chronic pain would also be candidates for PCA. PCA would be used as an adjunct therapy to treat the pain while the underlying cause gets diagnosed and treated. Common examples are vaso-occlusive pain crisis, trauma, pancreatitis, or burns. PCA can be useful in the acute pain setting where there is inadequate pain control from the initial opioid administration in the emergency department, and continued opioid dosing has been proven to improve patient outcomes. ![]() PCA can be used to reduce the stress on the nursing staff and the patient of having to adhere to a predetermined dosing schedule of as-needed analgesics that may not adequately align with the patient’s fluctuation of pain. PCA can be an option for acute, chronic, postoperative, and labor pain, especially in patients who are unable to tolerate oral medications. Transdermal PCA delivery is through a fentanyl iontophoretic transdermal system, which is placed on the epidermis and will provide a dose of fentanyl when the patient pushes a button on the patch. These will run through the skin and potentially muscle depending on the desired target location. Peripheral nerve catheters are placed adjacently to the nerve or plexus they are intended to block continuously. Indwelling epidural catheter placement is at thoracic and lumbar spinal levels. Within the epidural space sits spinal nerves, blood vessels, and fat. Epidural catheters placement is in the epidural space between the dura and the ligamentum flavum, which lines the anterior portions of the vertebral lamina. Central lines placed in the internal jugular, subclavian, or femoral veins. Any peripheral vein can be used to insert a catheter and begin the administration of PCA. Modalities for PCA administration include intravenous lines, central lines, epidural catheters, peripheral nerve catheters, or transdermal delivery systems.
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