Cessation of IV patient-controlled analgesia (PCA) in the postoperative period is often an arbitrary clinical decision. We conducted a prospective survey of patients 24 h after cessation of IV PCA morphine to determine whether they wished to be restarted on PCA, and to evaluate factors affecting this decision. One hundred and fifteen patients were surveyed over a 3-mo period. Thirty-eight patients (33%) wished to restart PCA. The most common reason was the expectation that IV 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 who did not wish to restart PCA were minimal pain (51.9%), inconvenient PCA machine (15.6%), ineffective analgesia by IV PCA (11.7%), side effects during PCA (11.7%), and wishing to tolerate pain (7.8%). PCA morphine consumption in the 24-h period before cessation of PCA (mean [SD]) was larger in patients wishing to restart PCA than in those who did not (21.1 [14.8] mg vs 15.1 [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 decision and with subsequent pain treatment. Morphine consumption may predict a patient's acceptance of ceasing PCA.
Implications: We surveyed patients 24 h after cessation of IV patient-controlled analgesia (PCA). This survey revealed that the usual clinical reasons to stop IV PCA might not be the most appropriate. Patients have different reasons why they wish to restart or not restart IV PCA. The cessation of PCA should be individualized.