Strengths: Up to date, well referenced, practical and easy to read; especially useful for anyone interested in the use of patient-controlled analgesia (PCA) in managing acute pain in postsurgical and obstetric care; includes factors to consider when establishing, organizing and monitoring an acute-pain service
Weaknesses: British brand names of PCA machines and drugs; however, North American brand names are often included
Audience: Health care professionals interested in acute pain management
Following a brief introductory discussion of postoperative pain, which stresses the need to provide timely, effective analgesia, the author presents a historical perspective on the introduction of patient- controlled analgesia (PCA) in clinical practice.
In the ensuing 10 chapters, important practical issues in the appropriate, safe use of PCA are comprehensively covered. Topics addressed include efficacy and safety of PCA; descriptions and operational pros and cons of several PCA machines in common use; drugs for PCA (choices, rationale, advantages and disadvantages, pharmacokinetics, protocols, storage, handling, distri-bution, antitampering precautions, routes of administration and complications); monitoring of respiratory depression; methods of measuring pain, including the linear visual-analogue scale, word-category scales, the smiley-face chart and the behaviour chart; methods of measuring sedation; and psychologic aspects of pain management.
I found the chapter devoted to the organization of a PCA service well organized and useful. The tables and approach to the administrative and quality-of-care aspects are valuable. The concluding chapter on funding is useful but needs to be adapted to Canada.
This booklet contains a considerable amount of detailed, practical information, concisely written. The format is reader friendly: subject headings are in bold type, and key summary information is set out in boxes. The references quoted are pertinent, broadly based (British, North American and European) and up to date.
Overall, Patient Controlled Analgesia is a useful resource that I would recommend to any health care professional wishing to review or learn more about PCA. For health care providers involved in running or establishing an acute-pain service, which includes PCA, there are many useful tips and ideas concerning quality of care and monitoring of the service.
Jean E. Swenerton, BA, MD, FRCPC
Department of Anaesthesiology
British Columbia's Women's Hospital
and Health Centre Society
Vancouver, BC