Patient-Controlled Analgesia

A 52-year-old man undergoes total abdominal hysterectomy for uterine fibroids under general anesthesia. On postoperative day 1, he is prescribed intravenous patient-controlled analgesia (IV-PCA) with morphine. The settings are: demand dose 2 mg, lockout interval 10 minutes, 4-hour limit 30 mg. At 6 hours postoperatively, the patient complains of inadequate pain relief despite pressing the button 8 times in the past hour. His respiratory rate is 18/min, oxygen saturation 96% on room air, and he is alert and oriented. What is the most appropriate next step in management?

During audit of your postoperative analgesia service, you review 200 patients who received intravenous PCA with morphine. Which is the most common reason for PCA pump lockout (demand exceeding delivery) in the first 24 hours?

A 52-year-old man with a history of chronic back pain (on long-term morphine 60 mg daily) is prescribed PCA morphine post-operatively. Regarding PCA programming in opioid-tolerant patients, all of the following are appropriate EXCEPT:

A 52-year-old man is 4 hours post-op following open cholecystectomy. He is on intravenous PCA with fentanyl (20 mcg bolus, 8-minute lockout). He reports severe pain (8/10) and has pressed the demand button 15 times in 20 minutes, but the pump has delivered only 3 boluses. He is drowsy but arousable, respiratory rate is 14/min, SpO₂ is 96% on room air, and blood pressure is 135/88 mmHg. What is the most appropriate next step in management?

Which feature best distinguishes intravenous patient-controlled analgesia (IV-PCA) from epidural patient-controlled analgesia (EPCA) in the postoperative setting?