Patient-controlled analgesia (PCA) has been widely implemented to provide better pain relief and increased patient satisfaction with relatively few side effects. However, patients using intravenous (IV) PCA are at increased risk for specific adverse effects, especially respiratory depression. A review of the literature from 1990 to present was done to identify the incidence and risk factors for respiratory depression and recommendations for care. Several studies have documented the incidence of respiratory depression with IV PCA; rates ranged from 0.19% to 5.2%. Variation in incidence existed because authors defined respiratory depression differently. Methods for monitoring oxygenation include sedation; respiratory rate, depth, and rhythm; and oxygen saturation using pulse oximetry. No single parameter is the single indicator for respiratory depression. Risk factors for respiratory depression with IV PCA include age greater than 70 years; basal infusion with IV PCA; renal, hepatic, pulmonary, or cardiac impairment; sleep apnea (suspected or history); concurrent central nervous system depressants; obesity; upper abdominal or thoracic surgery; and IV PCA bolus >1 mg. Structures and processes should be in place to guide appropriate dosing, identify risk factors, and activate pertinent monitoring and frequency. Finally, respiratory depression occurs infrequently in comparison to the 10% of patients who are undertreated for pain.
Mary E. Hagle, PhD, RN, AOCN, Nursing Practice Specialist, Center for Nursing Research and Practice, Aurora Health Care, Milwaukee, WI.
Victoria Tutag Lehr, PharmD, Associate Professor, Department of Pharmacy Practice, The Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI.
Karen Brubakken, MS, RN, CS, Case Manager, Care Management, Aurora Health Care, Milwaukee, WI.
Angela Shippee, BSN, RN, Staff RN and Chairperson, Metro Nursing Practice Council, Aurora Health Care, Milwaukee, WI.
The authors have no conflict of interest.