• Ivy Benjenk, Jonathan Messing, Megan J Lenihan, Madelyn Hernandez, Richard Amdur, Sarah Sirajuddin, Danielle Davison, Mary E Schroeder, and Babak Sarani.
• Ivy Benjenk is a senior clinical analyst, Center for Trauma and Critical Care, George Washington University Hospital, Washington, DC.
• Crit Care Nurse. 2020 Jun 1; 40 (3): 31-36.

BackgroundPatient-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.ObjectiveTo evaluate the efficacy of authorized agent-controlled analgesia in critically ill adult patients.MethodsA 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.ResultsThe 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).ConclusionsUse of authorized agent-controlled analgesia is associated with a reduction in pain in critically ill patients. Larger studies are warranted to confirm these findings.©2020 American Association of Critical-Care Nurses.

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