P

patient controlled analgesia (PCA) The postop-
erative self-administration of intravenous (IV) PAIN
relief (analgesic) medication. PCA requires an IV
(a thin catheter inserted into a VEIN), a PCA pump
that contains a special syringe with the pain med-
ication, and a PCA control button. Each time the
person depresses the PCA button the PCA pump
releases a certain amount of pain medication from
the syringe into the IV. Most people feel pain relief
within a few minutes of pressing the button.
The PCA pump can release medication only
according to the amount and frequency for which
it is programmed, no matter how often the person
presses the button, so there is no danger of receiv-
ing too much. An alarm on the PCA pump notifies
nursing staff when the amount of medication in
the syringe gets low or when there is any disrup-
tion of the pump’s proper function. The PCA
pump may also be programmed to deliver a steady
flow of pain relief medication, with extra medica-
tion released with the button as the person needs
it to maintain comfort.
Numerous studies show that people tend to
have less anxiety about postoperative pain and
pain relief and use less pain relief medication with
PCA. As well, appropriate pain control facilitates
faster HEALING. Within a few days after an OPERA-
TIONmost people are able to switch to oral (by
MOUTH) pain medications.
See also ANALGESIC MEDICATIONS; SURGERY BENEFIT
AND RISK ASSESSMENT.

plastic surgery Any surgical OPERATIONto alter
the appearance of a body area or part. Plastic sur-
gery may be reconstructive (re-creates or repairs a
body part that is damaged or missing) or cosmetic
(changes physical appearance for reasons of per-
sonal preference). Though both disciplines encom-

pass elective operations, the US health-care sys-

tem considers reconstructive surgery to be med-

ically necessary; therefore, health insurance plans

typically pay for reconstructive operations. Cos-

metic surgery operations are not medically neces-

sary and health insurance plans seldom pay for

them.

In some circumstances the nature of a plastic

surgery operation overlaps between cosmetic and

reconstructive. For example, a person may desire

RHINOPLASTY(NOSEalteration) because of dissatisfac-

tion with the nose’s appearance, though the sur-

geon’s examination leads to the discovery that the

person also has a deviated septum, which affects

BREATHINGand the health of the SINUSES. A person

may seek plastic surgery to alter the perception of

aging that arises from drooping eyelids, and then

discover the eyelids obscure the field of vision.

Reconstructive Surgery

Reconstructive surgery rebuilds missing or lost

structures with the goal to restore function. The

loss may be due to numerous factors that include

CONGENITAL ANOMALY, traumatic injury, BURNS, dis-

ease processes, and surgical treatment for condi-

tions such as cancer. Reconstructive surgery is

often complex and requires multiple operations to

achieve the desired result. Reconstructive opera-

tions performed in childhood may need revision

as the child grows. Reconstructive surgeons may

coordinate care and treatment with surgeons and

physicians in other specialties such as orthopedics

(bones and connective tissues) and neurology

(nerves). Doctors often request a plastic surgeon

to suture or otherwise repair LACERATIONS and

wounds to the face or hands. Plastic surgeons per-

form about five million operations a year in the

United States.

274