A prospective survey of patients after cessation of patient-controlled analgesia

Cessation of IV patient-controlled analgesia (PCA) in the postoperative per iod is often an arbitrary clinical decision. We conducted a prospective sur vey of patients 24 h after cessation of TV PCA morphine to determine whethe r they wished to be restarted on PCA, and to evaluate factors affecting thi s decision. One hundred and fifteen patients were surveyed over a 3-mo peri od. Thirty-eight patients (33%) wished to restart PCA. The most common reas on was the expectation that TV PCA would be more effective. Age, sex, type of surgery, duration of PCA use, side effects, pain scores, and reasons for cessation of PCA did not affect the decision. The reasons given by those w ho did not wish to restart PCA were minimal pain (51.9%), inconvenient PCA machine (15.6%), ineffective analgesia by TV PCA (11.7%), side effects duri ng PCA (11.7%), and wishing to tolerate pain (7.8%). PCA morphine consumpti on in the 24-h period before cessation of PCA (mean [SD]) was larger in pat ients wishing to restart PCA than in those who did not (21.1 [14.8] mg vs 1 5.1 [15.1] mg; P < 0.05). In conclusion, the clinical decisions to cease IV PCA do not predict patient acceptance of and satisfaction with the decisio n and with subsequent pain treatment. Morphine consumption may predict a pa tient's acceptance of ceasing PCA.