When IV PCA is prescribed for postoperative patients, it should be initiated whenever possible in the PACU. This allows the healthcare team to evaluate patient response to the therapy early in the postoperative course and prevents delays in analgesia (analgesic gaps) on the clinical nursing unit (Pasero, Quinn, Portenoy, McCaffery, & Rizos, 2011). A particularly dangerous scenario to avoid is that of patients receiving IM opioid injections on the clinical unit while waiting for IV PCA to be initiated.
The PCA button should be given to patients as soon as they are awake and alert enough to understand the intent and use of the PCA. At that time, pain management plans can be reviewed with patients, including what action to take when pain relief is inadequate. PACU nurses can reinforce the safety mechanisms of the PCA pump and how to correctly use the PCA button, reminding patients that it is for their use only.