If the federal government decided that the nation’s automakers were no longer required to publicly announce recalls of cars equipped with life-threatening defects, the protest from the masses would be deafening.
By Kenneth P. Rothfield, M.D., M.B.A., Chairman, Department of Anesthesiology, Saint Agnes Hospital (Baltimore, MD), Lynn Razzano, RN, MSN, ONCC (Clinical Nurse Consultant, Physician-Patient Alliance for Health & Safety), and Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)
The mother of Leah Coufal, Lenore Alexander is Executive Director of Leah’s Legacy, a non-profit advocate for mandatory electronic monitoring of patients on opioids. She may be reached at email@example.com
Patient Controlled Analgesia (PCA) pumps were developed to address the problem of undermedication. They are used to permit the patient to self-administer small doses of narcotics (usually Morphine, Dilaudid, Demerol, or Fentanyl) into the blood or spinal fluid at frequent intervals. PCA pumps are commonly used after surgery to provide a more effective method of pain control than periodic injections of narcotics. This method of pain control has been found to result in less pain and earlier discharge from the hospital. PCA pumps can be effectively used by children as young as six years old. A continuous infusion (called a basal rate) of 1-2 mg/hour permits the patient to receive a continuous infusion of pain medication. This mode of delivery is now used only for patients who have had prior opioid use or are not “opioid naïve”. The risk of respiratory depression is too great in patients who have not built up a tolerance to opioids. Typically the patient receives an intravenous “loading” dose to quickly raise the blood level of the pain medication.