title: Institutional survey of nurse anesthesia practice in patients receiving opioids via patient-controlled analgesia.
abstract: 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.
authors.forename: B A
authors.initials: BA
authors.lastname: Dixon
mesh_terms: D016058:Analgesia, Patient-Controlled / Q000451:nursing*; D002908:Chronic Disease; D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement; D006801:Humans; D009294:Narcotics / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications*; D009719:Nurse Anesthetists / Q000193:education / Q000592:standards; D015403:Nursing Evaluation Research; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'
chemical_list: D009294:Narcotics