Lehmann K A
Klinik für Anästhesiologie und operative Intensivmedizin, Universität zu Köln.
Zentralbl Chir. 1995;120(1):1-15.
Patient-controlled analgesia (PCA) is a newer technique for pain management. Patients are allowed to self-administer small analgesic bolus doses, which have been preprogrammed by the physician, into a running intravenous infusion, intramuscularly, subcutaneously or even into the epidural space. Patients' demands are mostly controlled by computer-driven infusion pumps, but can also be delivered by simple disposable devices. Lockout times, concomitant infusions and hourly maximum doses can be set in most PCA pumps. Clinical experience with PCA demonstrates that individual variability in pain sensitivity and analgesic needs are of utmost importance. In contrast to earlier expectations, PCA opiate consumption is usually higher than with restrictive conventional dosing regimes, but without an increase of serious side effects. Such results let assume that many patients under conventional i.m. techniques must be considered to be underdosed. Patients acceptance is generally enthusiastic for self-control. It is suggested that PCA results should be used for the improvement of conventional techniques. PCA has also been found valuable for scientific pain studies, e.g. to determine predictors of postoperative pain, drug interactions and pharmacokinetic experiments. This review concentrates on intravenous PCA during the early postoperative period.
患者自控镇痛（PCA）是一种较新的疼痛管理技术。患者可以自行将医生预先设定好的小剂量镇痛推注药物，通过静脉持续输注、肌肉注射、皮下注射甚至硬膜外腔给药。患者的需求大多由计算机驱动的输液泵控制，但也可以通过简单的一次性装置给药。大多数PCA泵可以设置锁定时间、同时输注量和每小时最大剂量。PCA的临床经验表明，疼痛敏感性和镇痛需求的个体差异至关重要。与早期预期相反，PCA的阿片类药物消耗量通常高于限制性传统给药方案，但严重副作用并未增加。这些结果表明，许多接受传统肌肉注射技术治疗的患者可能剂量不足。患者对自我控制普遍持积极态度。建议将PCA的结果用于改进传统技术。PCA在科学疼痛研究中也很有价值，例如确定术后疼痛的预测因素、药物相互作用和药代动力学实验。本综述主要关注术后早期的静脉PCA。
