Authorized Agent–Controlled Analgesia for Pain Management in Critically Ill Adult Patients

Patient-controlled analgesia is commonly used for adult patients requiring parenteral opioid analgesia in the postoperative setting. However, many patients are unable to use patient-controlled analgesia because of physical or cognitive limitations. Authorized agent–controlled analgesia, in which a nurse or family member activates the patient-controlled analgesia device, has been studied in the pediatric population but has received little attention in adults.

To evaluate the efficacy of authorized agent–controlled analgesia in critically ill adult patients.

A retrospective pilot study was conducted involving 46 patients who were placed on an authorized agent–controlled analgesia protocol in a mixed medical/surgical adult intensive care unit. Critical-Care Pain Observation Tool scores were abstracted for the 24 hours before and after initiation of authorized agent–controlled analgesia. Authorized agent–controlled analgesia was administered by nurses only.

The mean (SD) change in pain score was –3.4 (2.0) (95% CI, –4.0 to –2.7), representing a 69% decrease in the mean (SD) pain score from before to after initiation of authorized agent–controlled analgesia (4.8 [1.8] vs 1.5 [1.6]; P < .001). When the results were controlled for time, sedative administration, and opioid medication administration, the effect of authorized agent–controlled analgesia initiation on pain scores remained significant (P < .001).

Use of authorized agent–controlled analgesia is associated with a reduction in pain in critically ill patients. Larger studies are warranted to confirm these findings.