PCA can be an option for acute, chronic, postoperative, and labor pain, especially in patients who are unable to tolerate oral medications. Transdermal PCA delivery is through a fentanyl iontophoretic transdermal system, which is placed on the epidermis and will provide a dose of fentanyl when the patient pushes a button on the patch.
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These will run through the skin and potentially muscle depending on the desired target location. Peripheral nerve catheters are placed adjacently to the nerve or plexus they are intended to block continuously. Indwelling epidural catheter placement is at thoracic and lumbar spinal levels. Within the epidural space sits spinal nerves, blood vessels, and fat. Epidural catheters placement is in the epidural space between the dura and the ligamentum flavum, which lines the anterior portions of the vertebral lamina. Central lines placed in the internal jugular, subclavian, or femoral veins. Any peripheral vein can be used to insert a catheter and begin the administration of PCA. Modalities for PCA administration include intravenous lines, central lines, epidural catheters, peripheral nerve catheters, or transdermal delivery systems.
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