This preliminary study determined certified registered nurse anesthetist (
CRNA) practice experience and educational needs in the preoperative evaluation of patients using
patient-controlled analgesia (PCA) for chronic and
cancer pain management. A convenience sample (N = 29) of CRNAs practicing in a university teaching hospital completed the surveys developed by the investigator. Survey items related to
CRNA experience with management of patients using PCA preoperatively, PCA modes of
opioid delivery, and use of adjuvant medication for chronic and
cancer pain patients. Results of the study indicated that 79% of CRNAs reported experience in administration of
anesthesia to one or more patients who used PCA preoperatively. However, only 32% of CRNAs surveyed reported knowledge of the modes of
opioid delivery available. Results also indicated that 48% of CRNAs were not familiar with adjuvant medications (ie,
tricyclic antidepressants,
benzodiazepines,
steroids, and
anticonvulsants), which are often prescribed in combination with
opioids in
chronic pain management. The respondents reported use of a variety of methods in handling
opioid and infusion devices for patients using PCA preoperatively. Fifty-two percent of CRNAs disconnected the infusion and discarded the
opioid preoperatively. Fourteen percent reported leaving the PCA device connected to the patient for use perioperatively or for continued
pain management postoperatively. Based upon the findings of this preliminary study,
CRNA education in management techniques for the use of PCA infusions in chronic and
cancer pain is recommended.