Patient Controlled Analgesia (PCA) & Nurse Controlled Analgesia (NCA)

Key points about PCA and NCA 

• PCA and NCA help manage your child’s pain
• they give a safe amount of pain medicine (usually morphine) when needed
• NCA is used if your child cannot use the pump themselves
• a health professional will check your child regularly to make sure they are safe and comfortable

What are PCA and NCA?

Patient or nurse controlled analgesia (PCA or NCA) is a way to give tamariki (children) pain relief when they need it. Analgesia means pain relief.

PCA and NCA use a pump that delivers a set amount of pain medicine (usually morphine) when someone presses a button. With PCA, your child presses the button. With NCA, the nurse presses it.

There may also be a small amount of pain medicine running continuously.

Uses of PCA and NCA

PCA and NCA give pain relief medicine, usually morphine. Morphine is a strong medicine used to treat moderate to severe pain.

A health professional often gives morphine after an operation. It can also help manage pain from a medical condition or injury.

How PCA and NCA work

PCA and NCA connect to an IV line

After surgery, a health professional connects the PCA or NCA pump to your child’s intravenous (IV) line.

An IV line is a thin plastic tube (cannula) placed in your child’s vein. This allows medicine to go straight into the bloodstream so it can work quickly.

IV Line (Cannula)

For PCA your child will control a hand-held button

With PCA, your child uses a hand-held button connected to the pump. When they press the button, the pump gives a small, safe amount of morphine into their IV line. The medicine usually starts to work within 5 to 10 minutes. If your child is still uncomfortable, they can press the button again.

A health professional sets up the pump before connecting it to your child’s IV line. They programme it to give a safe amount. It will only allow one dose every 5 to 10 minutes, even if your child presses the button more often.

For NCA the nurse will press the button

An NCA pump works in the same way as a PCA pump. Instead of your child pressing the button, the nurse presses the button to give pain relief when your child needs it.

Differences between PCA and NCA

PCA

With PCA, your child controls the button and can decide when to have pain relief. This allows them to manage their pain without asking a nurse.

Your child must be the only person to press the button.

Before starting PCA, a health professional will check that your child:

• is old enough to understand how the pump works
• can physically press the button
• knows when to use the button and for what type of pain

NCA

If PCA is not suitable, your child will use NCA. This works in a similar way, but the nurse presses the button to give a safe dose after assessing your child.

Only the nurse should press the button.

Some tamariki start with NCA and later change to PCA as they recover and become more alert after surgery.

Will my child need extra pain relief? 

Some tamariki may have a continuous morphine infusion running through the pump. This gives a steady, small amount of morphine into the IV line without needing to press a button.

If your child is still uncomfortable, they may have extra doses through the pump using PCA or NCA.

See the page on Morphine Infusions for more information.

Morphine Infusion

PCA and NCA safety

PCA and NCA are very safe when only your child or the nurse presses the button. Parents and caregivers should not press the button.

The pump has safety features to prevent giving too much medicine. It ‘locks out’ for a set time, so pressing the button again will not give more medicine. The pump is set to stay within a safe maximum dose. It is also locked with a key so no one can change the settings.

Checking the PCA or NCA

The nurse will regularly check on your child to make sure they are safe and comfortable. If there are any problems, they will contact the specialist pain team.

Possible side effects from PCA or NCA

Sometimes morphine can make your child feel sleepy and slow their breathing. Health professionals will watch closely for these signs. They can give another medicine to quickly reverse these effects if needed.

Morphine can also cause nausea (feeling sick) or itching. Adjusting the dose or giving other medicines can help.

While your child is using PCA or NCA, health professionals will regularly check:

• their pain level
• level of sleepiness
• if they are having any side effects

How long will my child need PCA or NCA? 

Tamariki usually use PCA or NCA for a short time after an operation. It may be used for around 24 hours, or until your child can eat and drink.

The specialist pain team will check your child’s pain each day. Once your child is eating normally, they can switch to pain medicine by mouth and the pump can be turned off.

Can my child become addicted to morphine?

No. When morphine is used for a short time to manage pain, your child will not become addicted.