Based on a recent audit done by Eri (APS NP) [please see below], it is clear that the majority of patients undergoing spine surgery DOES NOT require IV PCA as 1st line.
We have successfully moved away from IV PCA use after TKA (and hip) with the option of using a small dose of IV push opioids prn. This method should also work well for most patients after spine surgery. Please order IV PCA as a 3rd option (to be started after failure of both po prn and IV push prn)
The usual predictors (chronic opioid use, young, female, high level of anxiety) is still relevant and seems to predict high opioid use better than the procedure.
IV PCA is costly in terms of cassette (also keep in mind the environmental cost of plastics, medication wasted etc).
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