Patient Controlled Analgesia (PCA) and Nurse Controlled Analgesia (NCA) for Pain Relief in Children

This booklet will help you understand more about your child’s PCA or NCA pump and how it works to provide pain relief for your child.

What does Analgesia mean?

Analgesia is another name for pain relief medicine, usually morphine, but sometimes other medicines are used.

What is Patient Controlled Analgesia (PCA)?

PCA is a way of giving pain relief to children and adults using a special pump. The pump gives an amount of analgesia all of the time (continuously) and extra amounts are given when a button is pressed (boluses) if pain becomes too much. With PCA, the patient (your child) controls the extra amounts by pressing the button themselves.

What is Nurse Controlled Analgesia (NCA)?

NCA is another method for giving pain relief to children and adults using a special pump. With nurse-controlled analgesia (NCA), a nurse decides when your child receives pain relief. This method is usually used when the child is too young or unable to press the button.

Why use PCA/NCA?

Using PCA/NCA enables the amount of pain-relieving medicine given to be increased as needed.
For older children, the idea of being in control of their pain medicine is often very helpful.
Your child will have other pain-relieving medicines such as paracetamol or ibuprofen as well as the PCA/NCA. These may be given by mouth or in the cannula. These medicines will help keep your child as comfortable as possible.

How does it work?

PCA

The special pump is programmed to give a small amount of analgesia all the time. This may not be enough, on its own, to keep your child comfortable. When your child starts to feel uncomfortable, they can press the button to receive an extra amount of the pain relief medicine.
This is a picture of the PCA pump. The button on the handset is pressed to ‘tell’ the machine to give extra analgesia.

Patient Controlled Analgesia

The machine will ‘beep’ to let your child know they have pressed it properly. Pressing the button ‘tells’ the machine to give a dose of analgesia, called a “bolus”. This dose has been calculated using the weight of your child. Once the analgesia is in your child’s blood, it takes about 5-10 minutes to have its full effect.

NCA

This works in a similar way to PCA except that the pump is programmed to give more analgesia all the time. This may be enough to keep your child comfortable, but, if necessary, the nursing staff can give extra amounts of analgesia by pressing the button.

Can anyone have PCA or NCA?

Any child who needs strong pain relief can use PCA/NCA, except children who are allergic to the medicine used.

Will my child have any side effects?

All medicines can cause unwanted side effects.

  • Morphine, the pain-relieving medicine we usually use, can make some children feel sleepy, dizzy, itchy or they vomit. It can also cause constipation.
  • Occasionally, some children may find it difficult to pass urine.
  • Very occasionally the analgesia can make children so sleepy that it affects their breathing.
  • Rarely, some children may have vivid dreams or may say ‘strange’ things.

If your child experiences any of these symptoms, please let the nursing staff know. Other medicines can be given to relieve itching, sickness and constipation. Sometimes changing the programming of the pump can also help.

Is it safe?

The PCA pump has several safety features:

  • A ‘lockout period’, analgesia is not given every time the button is pressed
  • The pump keeps a record of the number of times the button is pressed
  • The amount of analgesia given to your child is also recorded in his/her medical record

Can this make my child addicted to analgesia?

Some children and their parents/carers are concerned about using these medicines because they are worried about the possibility of addiction. This is extremely rare. If children need these medicines for a longer period of time, we reduce them more slowly so that they do not experience any side effects from this.

When will the PCA/NCA be stopped?

Most children have PCA/NCA for 24-72 hours after their surgery. It will be stopped sooner if it is not needed or if your child has side effects that we cannot manage effectively. Once the PCA/NCA is stopped, your child will continue to receive other pain-relieving medicines such as paracetamol, ibuprofen or oral morphine as needed.

Who will look after my child?

Your child’s nurse will:

  • Carry out regular checks (observations) of your child whilst they have their PCA/NCA.
  • Assess how comfortable your child is, whether they have passed urine and how sleepy they are.
  • Monitor your child’s heart rate, blood pressure and breathing.
  • Check if your child is having any side effects from the analgesia. These checks will be carried out regularly and at least every four hours.

Also, your child will be seen daily by an anesthetist or specialist pain nurse.

What can I do to help?

  • If your child has a PCA pump, you can remind them to press the button when they feel sore, or before they move.
  • If you feel that they are uncomfortable or are not managing to use the PCA, you should tell your nurse.
  • Don’t press the button yourself.
  • If your child has an NCA pump then you should let the nurses know if they are sore, or if they want to move, and the nurse can press the button. Again, please don’t press the button yourself.

Are there any alternatives?

Other pain-relieving techniques may be more suitable and your child’s anesthetic doctor will discuss this with you and your child.

The Pain Team

The hospital has a team of Specialist pain nurses and anesthetists, who help to look after children who may be in pain after their surgery. They work closely with nursing staff in the unit to make sure that your child is as comfortable as possible.
If you have any questions about pain control, please ask a member of the nursing staff. If they cannot answer your questions, they will contact a member of the Pain Team.

What should I do when we go home?

Before your child is discharged from hospital, the nurses will check that your child is comfortable. They will explain to you what types of medicine to give at home and how to give it. Your child may need to have medicine such as paracetamol or ibuprofen regularly for a few days to keep them comfortable.
If you have any concerns, please speak to your child’s doctor or nurse.