Analgesic gaps should be avoided where possible. Two reasons why patients may experience gaps in treatment are staff response time and equipment issues.1,2 When analgesia is administered by nurses upon the request of the patient, time delays can result in treatment gaps. Studies show that with nurse-administered treatments, patients can experience a delay of 20-40 minutes between feeling pain and receiving analgesia.1,2

Analgesic gaps in POPM

With regard to equipment related analgesic gaps – a study has shown that 12% of patients treated with IV PCA suffer analgesic gaps due to equipment issues. Potential equipment issues with IV PCA are, for example, infiltration, device malfunction or failure, line pulled out, leaking, obstructed or air in line and low or dead batteries.3 Furthermore, a catheter occlusion can also lead to analgesic gaps. According to a study from 2014, 25% of peripheral intravenous catheters fail due to occlusion. Small needle diameter and female gender are risk factors for occlusion.4

Approaches to help avoid or minimise analgesic gaps are, for example:

  • Analgesic gaps can be minimised by maximizing efficiency or using patient-controlled analgesia.5
  • Training can help reduce the likelihood of the above equipment issues and to identify and manage them when they do occur.6



1 Chan VW et al. Impact of patient-controlled analgesia on required nursing time and duration of postoperative recovery. Reg Anesth. 1995; 20: 506-14.
2 Graves DA et al. Patient-controlled analgesia. Ann Intern Med. 1983; 99: 360-6.
3 Panchal SJ et al. System-related events and analgesic gaps during postoperative pain management with the fentanyl iontophoretic transdermal system and morphine intravenous patient-controlled analgesia. Anesth Analg. 2007; 105: 1437-41.
4 Wallis MC, McGrail M, Webster J, et al. Infect Control Hosp Epidemiol. 2014; 35: 63-8.
5 Carr DB et al. The impact of technology on the analgesic gap and quality of acute pain management. Reg Anesth Pain Med. 2005; 30: 286-91.
6 Grass JA et al. Patient-controlled analgesia. Anesth Analg. 2005; 101: S44-S61.


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