PCA, NCA and continuous analgesia infusion

What is PCA, NCA and continuous analgesia infusion?

Analgesia is just a word for a type of medicine that relives pain (painkillers).

Children who are given good pain control (analgesia) tend to make a faster recovery.

Patient controlled analgesia (PCA) and nurse controlled analgesia (NCA) and continuous analgesia infusions are all ways of delivering strong pain relief to your child depending on their needs.

Why use PCA?

PCA allows your child to have control over their pain and safely give themselves strong pain relief. It is usually morphine and is given by a special pump when they need it, straight away.

The pain medicine goes into the vein through an intravenous (IV) tube. The IV tube is connected to a pump, which is programmed to deliver pain relief medicine. The pain relief is only given to them when they press the button on the handset of the pump.

Children given the option to have PCA must understand that by pressing the button will give them pain relief.

Why use NCA?

NCA is similar to a PCA but is adapted for young children or those unable to use the button themselves.

It allows a nurse to safely give your child strong pain relieving medicine using the same special pump. Your child’s nurse will balance the needs of your child and the potential side effects of the pain relieving medicine.

Why use continuous analgesia infusion?

This is a way of giving pain relief medicine that works by flowing a constant amount of medicine in the bloodstream at all times.

It is delivered continuously by the PCA pump. This means your child will have more consistent pain relief which will help make movement, coughing and deep breathing exercises easier.

How do they work?

The computerised pumps used have safety features that allow strong pain medicine to be given through a drip or IV.

The pump programmed for your child, dependant on their weight.

The pump has a handset attached. When the button on the handset is pressed, a set dose of the pain relieving medicine will be given through the drip.

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 a ‘background’ pain relief.

If your child is having PCA, your child can press the button when they have pain. It can also be used just before painful procedures or moving around, such as when they need dressing changes or physiotherapy.

If your child is having NCA, the nurse will be able to press the button when your child has pain or just before painful they have procedures or moving around, just like the PCA.

It takes 5 to 10 minutes for the medicine to work. If your child is still sore then they can press the button again themselves, or ask their nurse if they are having NCA.

Safety

There are many safety features in the pump delivering the pain relieving medicine.

The key safety measure when using PCA or NCA is that only the child or nurse can press the button.

The pump 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 and how sleepy they are.

When the button is pressed and a dose of pain relieving medicine is given, the pump is programmed with a maximum dose per hour so that your child cannot give themselves too much medication by accident. Once the pump is pressed, it will give another dose for an amount of time. This is called the ‘lockout’ and is set according to the doctors instructions.

You play an important part in caring for your child as you know them best and can help with measuring your child’s pain at and between these checks.

Each day a member of the acute pain team will review your child and make necessary changes.

What are the side effects?

All medications can have side effects. Those usually experienced with PCA, NCA or continuous analgesia infusions are:

• drowsiness
• feeling sick and being sick
• itching
• altered mood
• unusual dreams
• difficulty weeing
• problems breathing

Nursing staff will check your child for any signs of these side effects. They can all be treated. Talk to the nurses or doctors if you are concerned about possible side effects.

What my child is still in pain?

The ward nurses will assess your child to see how effective the pain relief is. If your child is still in pain, other pain relieving medicines will be given as well to help them. Different pain relief medicines work in different ways and giving a combination means that your child will have the best pain relief possible.

If you child’s pain continues, the acute pain team or anaesthetic doctor will review your child and make changes to relieve their pain.

Will my child get addicted to the pain relieving medicines?

Your child will not be given enough medicine to become addicted. They need this pain relief and it is only used for 2 to 5 days.

What I do to help with my child’s pain?

Parents and carers play a very important part in pain management. You know your child best, so if you feel they are in pain please let the nurses know. If your child has a PCA then encourage them to press the button. Encouragement may also be needed for your child to take their milder painkillers by their mouth.

Talking, massaging and playing with your child can often distract them from their pain.

What is the pain team?

Here at the Sheffield Children’s hospital we have an acute pain team. This team consists of specialist nurses, a consultant anaesthetist, and an on-call anaesthetist. The pain team work closely with the ward staff to provide comfort for children in hospital through a variety of treatment approaches according to each child’s individual needs.

If you have any questions or concerns, please ask a member of the nursing staff. If they are unable to answer your questions they will contact a member of the pain team.