The acronym PCEA stands for Patient Controlled Epidural Analgesia, a method of pain control that is normally used after our PLIF/TLIF surgery.
During surgery, a fine tube is sited in your epidural space, a small canal that sits behind your spinal cord that can be seen on the diagram below. The epidural space is actually filled with many blood vessels and fatty tissue and is not empty as its name would suggest.
Epidural delivery of pain medication is very effective and fast acting. The drug, a local anaesthetic, is able to bind with certain receptors within the spinal cord which essentially stops the transmission of pain signals before they reach the brain. Unlike the PCA which acts on the body as a whole, we can be a lot more specific as to where the PCEA effect will be seen. This is controlled by the level at which the epidural catheter is placed.
Patient controlled devices are seen as vital in the control of pain due to its subjective nature. Like the PCA device there are two ways that the PCEA is set up to deliver an analgesic effect. First is the background dosing, this is a preset infusion that runs constantly allowing a continuous effect. The second is the bolus part which the patient has more control over. This allows a top up effect of a preset amount of drug should the level of discomfort rise above what is desirable. There is a lockout facility that runs automatically along side this to prevent you from topping up a little to much which can have negative side effects!
If you have lots of scar tissue within your epidural space, that may be resultant of chronic spinal conditions or previous surgery, there is a chance that the block may be patchy. This simply means that some areas may not be as well anaesthetised as others however in most people the ability to top up gets around this. Some hospitals will add a little opiate to the Local Anaesthetic such as morphine to increase its pain relieving effect however this has the potential to cause respiratory depression (your rate of breathing can drop significantly). This is not necessarily a problem when you are on an open ward but is is less desirable when you are in separate rooms as normally found in the private sector. For this reason, to get the extra relief ascertained from opiate useage we deliver it separately through a PCA device. Click Here for details.
The workings of the PCEA will be explained to you pre-operatively so that you are au fait with it when you return after surgery. If you have any other questions regarding this you should talk to your Anaesthetist at your preop assessment.
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