Patient controlled analgesia (PCA) utilizes a programmable pump that allows patients to self-administer parenteral opioids on demand. Used in hospitals since 1971, PCA is an effective and well-tolerated means of managing acute pain, including post-operative pain, as well as cancer, burn, and sickle-cell crisis pain.

Compared to other administration routes (po/sc/IM), PCA can provide better overall pain relief, greater patient control over pain, rapid treatment of incident pain (for dressing changes, etc.), more predictable drug absorption, lower drug consumption, and decreased nursing staff workload. Moreover, differences between patients in drug metabolism and effectiveness are minimized since each patient manages their PCA to the desired effect.

Conditions favorable for PCA use include the need for rapid opioid titration; moderate-severe pain; and frequent changes in pain intensity (e.g., incident pain). PCA therapy should be expected to be required for >48 hrs. Contraindications/relative contraindications for PCA include decreased comprehension/understanding (e.g., dementia, delirium, language barriers, age <7 years), poor or limited hand function, significant sleep apnea, severe lung disease, and poor renal function.