Consensus Summary on the Clinical Application of Patient-Controlled Analgesia for Pain Management in China

Patient-controlled analgesia (PCA) is a technique in which healthcare professionals preset the doses and administration parameters of analgesic drugs using a patient-controlled analgesic device according to the patient's pain intensity and physical condition, allowing patients to self-manage pain. PCA suppresses the stress and inflammatory responses caused by surgical trauma and nerve injury, reduces acute pain, alleviates the perioperative suffering of surgical patients, and accelerates postoperative recovery. The implementation of PCA requires specialized PCA pumps, which have undergone continual development and renewal over the past 30 years. With the rapid advancement of computer, network, and intelligent technologies in clinical medicine, China has developed an intelligent PCA (Ai-PCA) analgesic system, which has markedly improved the precision, reliability, and safety of pain management. However, challenges remain because of substantial individual differences in pain perception, the multiplicity of analgesic drug regimens, and suboptimal satisfaction with treatment outcomes. At the invitation of the Chinese Journal of Painology and led by the Anesthesiology Branch of the Chinese Medical Association, experts in anesthesiology and pain medicine were convened to develop this Chinese expert consensus on clinical application practice guidelines for patient-controlled analgesia. A comprehensive literature search was conducted in PubMed, Embase, Web of Science, Chemical Abstracts (USA), Wanfang Database, CNKI, Chinese core journals, Chinese scientific and technological statistical source journals, and EBSCO academic databases, covering PCA technology, clinical application, and perioperative management, from database inception to March 1, 2024. The quality of evidence was graded using the numerical rating scale (NRS), the visual analogue scale (VAS), and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system into four levels (high, moderate, low, and very low), and the strength of recommendations was determined by repeated discussion and revision of the working group and voting of the expert committee via a questionnaire, with consensus categorized as very strong, strong, weak, not reached, or rejected. This consensus provides assessments and recommendations on PCA drug formulation protocols, clinical PCA setting modes, and the management of adverse reactions, covering intravenous PCA (PCIA), epidural PCA (PCEA), subcutaneous PCA (PCSA), Subarachnoid PCA (S-PCA), target-controlled infusion PCA (TCI-PCA), and peripheral nerve block combined with PCA for multimodal analgesia. It applies to pain management in adults but not in children and provides practical guidance for clinical physicians toward the standardized, individualized, and intelligent clinical application of PCA.