Background: Intravenous Patient Controlled Analgesia is a  successful mode of analgesia delivery widely utilized in the management of postoperative pain, replacing the traditional model of intermittent or "prn" dosing by nurses. Evidence of application of this mode to postoperative oral analgesia as an alternative to the conventional nurse-administered mode is lacking.

Purpose: To compare Patient Controlled Oral Analgesia (PCOA) with the traditional mode of Nurse-Controlled Oral Analgesia (NCOA) in safety, analgesic efficacy, and patient satisfaction with overall pain management in the postoperative period.

Methods: Sixty-six adult subjects undergoing knee replacement and abdominal surgery were randomly assigned into the NCOA and PCOA treatment arms on the day of conversion from intravenous to oral analgesia. Safety was evaluated by monitoring for diversion and frequency of self-dosing compared to the physician orders. Analgesic efficacy was evaluated using a visual analogue scale and determining the number of doses meeting pain goals one hour after each oral analgesic intervention. Satisfaction was measured utilizing the subject’s verbal response to a Gallup Poll questionnaire two weeks post-discharge.

Findings: No identified incidents of diversion or self-dosing more frequently than ordered by the physician were reported. The PCOA group demonstrated a statistical difference in satisfaction when compared with the NCOA group (x5 = 6.533, df=1, p<0.011).There were significant differences in both the total number of doses (U= 30.00, P< 0.001) and the number of doses meeting the pain expectancy (U=58.00, p< 0.023) in the PCOA subjects. The mean percentage of doses meeting the patient’s goal in the PCOA group was 86% when compared with the NCOA group at 65%.