Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia

Table 1

Summary of research and development potential.

Aspect	Current issues	Imaginable developments and activities
Technology	(i) Safety (catheter-related and tablet diversion)	(i) Noninvasive administration without the potential of collectability of drug
	(ii) Invasive	(ii) Balance between contamination potential (prodisposal) and environmental aspects
	(iii) Contamination	(iii) Additional device safety features to counter side effects and adverse events
		(iv) Real-time monitoring
Pharmaceuticals	(i) Reduction or avoidance of opioids	(i) Assessment of nonopioids with fast onset and adequate potential for pain relief
	(ii) Long-acting local anaesthetics	(ii) Drug combinations to reduce the potential for side effects and adverse events
Processes	(i) Workload related to technology and route of administration	(i) Simplification of technology by considering noninvasive routes of administration
	(ii) Education	(ii) Introduction of new educational formats
Financials	(i) Reimbursement linked to patient outcome	(i) Education of budget decision makers concerning the importance of pain management in relation to patient outcome
	(ii) Cost of new products	(ii) Understanding within the supplying industry that only a measurable value-add leads to market adoption