ABSTRACT
INTRODUCTION Patient-controlled analgesia (PCA) devices have been used in the management of pain since the 1970s. Since that time, great improvements have been made in pain control and patient satisfaction related to pain control. Today, PCA is considered the standard of care for managing acute postoperative pain. Patients who desire to control their own pain and have the cognitive and physical capabilities of doing so are generally considered good candidates for PCA; however, some patients may not have the cognitive and/or physical capabilities to utilize PCA in an effective way. This may include patients at either end of the life span, those with severe dementia or impaired cognitive development, those with physically impairing neuromuscular or musculoskeletal diseases, intubated patients, comatose patients, and dying patients. The argument can be made that these patients, because of their inability to self-report pain or utilize a PCA device, are at greatest risk for unrecognized and undertreated pain, and often receive lesser-quality pain management. This has lead to the practice of authorized agent controlled analgesia (AACA).
