Nurse Controlled Analgesia (NCA) - information for parents/ carers

Children who have good pain management tend to recover faster. This leaflet contains information about:

• What a NCA is.
• What side-effects to look out for.
• How a NCA manages your child’s pain safely.

What is a NCA?

NCA stands for ‘Nurse Controlled Analgesia’. This is a type of pain relief that lets the nurse administer pain medicine depending on your child’s needs, if your child is unable to do this themselves. A small amount of pain medicine is given by pressing a button. The pain medicine we usually use is called Morphine, but there are other pain medicines that are related to Morphine that may be used. The prescriber will decide which one is best for your child. All the pain medicines used in the NCA are strong which will help reduce your child’s pain.

How does it work?

A NCA machine contains pain medication in a syringe; this is connected to a tiny tube called a cannula. This cannula may be put in whilst your child is in the operating theatre. Connected to the machine is a handset with a button on it. When your child has pain or just before a painful procedure the nurse can press this button, and the machine will give a small amount of pain relief medication through the cannula into their vein. The machine may also be set so that a small continuous amount of pain-relieving medicine is given all the time, in addition to the doses given when the button is pressed. The machine will be set for your child according to the prescriber’s orders.

Is a NCA safe?

Yes, but it is very important that the nurse is the only person who presses the button. If someone else presses the button for your child, it may make them too sleepy and very unwell. Your nurse will be checking their heart rate, breathing, pain level and how sleepy they are every hour. The nurse will assess your child’s pain using a pain assessment chart that is appropriate for their age and ability.

The machine has been specifically set by the prescriber so that it will lock for a short period of time after the nurse has pressed the button; this is so that the pain relief medication is given time to work before your child can get some more and to help stop your child from having too much pain medication and becoming too sleepy.

Why can only a nurse press the button?

Only the nurse may press the button to deliver the pain-relieving medicine because the nurse must first make an assessment of your child’s level of consciousness and pain to be sure it is safe and effective.

How will the NCA make your child feel?

Some children have said that they feel itchy or sick. It is important that you let the nurse know how they are feeling so that the nurse can give them other medicine to reduce these symptoms.

How long will your child need the NCA for?

This will depend on your child’s pain or the type of operation or illness your child has. . As your child gets better the button will need to be pressed less. Your child will be given other pain medicine such as Paracetamol alongside the NCA. When your child’s pain is improving and they can have other pain medicines, the NCA will be stopped.

Before stopping the NCA the nurse will assess your child to make sure pain is being appropriately managed. Your child will also carry on taking other medication that will help to manage their pain. Your child may need to continue some pain medicines when they get home.

Will your child get addicted to the pain medication in the NCA?

No, children do not become addicted to pain-relieving medicine as it is being given to manage pain after an operation or illness . Usually, your child will only need the pain medication through the NCA machine for a few days. If the NCA is used for more than a few days your child’s body may become used to the pain-relieving medication, in this case the NCA may need to be reduced slowly.

What do you do if you are worried?

You know your child best and we rely on that knowledge. If you have any worries or questions about your child’s pain management then please talk to the nurse. You could also ask your child’s nurse to call the children’s pain team or an anaesthetist to come and talk to you.