Finding the 'Ideal' Regimen for Fentanyl-Based Intravenous Patient-Controlled Analgesia: How to Give and What to Mix?.
10.3349/ymj.2014.55.3.800
- Author:
Seokyung SHIN
1
;
Keoung Tae MIN
;
Yang Sik SHIN
;
Hyung Min JOO
;
Young Chul YOO
Author Information
1. Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. seaoyster@yuhs.ac
- Publication Type:Original Article
- Keywords:
Analgesia;
patient-controlled;
fentanyl;
background infusion rate;
adjuvant drug
- MeSH:
Adult;
Aged;
Analgesia, Patient-Controlled/*adverse effects/*methods;
Female;
Fentanyl/administration & dosage/therapeutic use;
Humans;
Male;
Middle Aged;
Retrospective Studies;
Sex Factors
- From:Yonsei Medical Journal
2014;55(3):800-806
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: This analysis was done to investigate the optimal regimen for fentanyl-based intravenous patient-controlled analgesia (IV-PCA) by finding a safe and effective background infusion rate and assessing the effect of adding adjuvant drugs to the PCA regimen. MATERIALS AND METHODS: Background infusion rate of fentanyl, type of adjuvant analgesic and/or antiemetic that was added to the IV-PCA, and patients that required rescue analgesics and/or antiemetics were retrospectively reviewed in 1827 patients who underwent laparoscopic abdominal surgery at a single tertiary hospital. RESULTS: Upon multivariate analysis, lower background infusion rates, younger age, and IV-PCA without adjuvant analgesics were identified as independent risk factors of rescue analgesic administration. Higher background infusion rates, female gender, and IV-PCA without additional 5HT3 receptor blockers were identified as risk factors of rescue antiemetics administration. A background infusion rate of 0.38 microg/kg/hr [area under the curve (AUC) 0.638] or lower required rescue analgesics in general, whereas, addition of adjuvant analgesics decreased the rate to 0.37 microg/kg/hr (AUC 0.712) or lower. A background infusion rate of 0.36 microg/kg/hr (AUC 0.638) or higher was found to require rescue antiemetics in general, whereas, mixing antiemetics with IV-PCA increased the rate to 0.37 microg/kg/hr (AUC 0.651) or higher. CONCLUSION: Background infusion rates of fentanyl between 0.12 and 0.67 microg/kg/hr may safely be used without any serious side effects for IV-PCA. In order to approach the most reasonable background infusion rate for effective analgesia without increasing postoperative nausea and vomiting, adding an adjuvant analgesic and an antiemetic should always be considered.
