Patient-controlled analgesia intravenous

Dosages and routes of administration Morphine is available in different salt forms but the hydrochloride and sulfate (Vermeire and Remon, 1999) are used preferentially. The compound can be administered by the oral, parenteral or intraspinal route. Oral application is preferred for chronic pain treatment and various slow release forms have been developed to reduce the administration frequency to 2-3 times per day (Bourke et al., 2000). Parenteral morphine is used in intravenous or intramuscular doses of 10 mg, mostly for postoperative pain and self-administration devices are available for patient-controlled analgesia (PCA). Morphine is additionally used for intraspinal (epidural or intrathecal) administration. Morphine is absorbed reasonably well in the lower gastrointestinal tract and can be given as suppositories. 

Medico-technical instruments such as infusion pumps can be used in PCA (patient-controlled analgesia, Fig. 1) to provide patient-orientated and therapy as required, e.g. with morphine injection solutions. Depending on the patients perception of pain, they may add small doses of analgesics to the basic infusion by means of an electrically controlled infusion pump. The physician specifies the basic dose, which is infused independent of patient demands, the boluses that can be demanded, an hourly maximum dose and a refractory time that cannot be reduced between two doses. The infusion may be given intravenously, subcutaneously, epidurally or intraspinally. 

Alon E, Jaquenod M, Schaeppi B. Post-operative epidural versus intravenous patient-controlled analgesia. Minerva Anestesiol. 2003 69 443—4-46. 

Aygun S, Kocoglu H, Goksu S, et al. Postoperative patient-controlled analgesia with intravenous tramadol, intravenous fentanyl, epidural tramadol and epidural ropivacaine + fentanyl combination. EurJ Gynaecol Oncol. 2004 25 498-501. 

Chen JY, Wu GJ, Mok MS, et al. Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients—a prospective, randomized, double-blind study. Acta Anaesthesiol Scand. 2005 49 546-551. 

Lebovits AH, Zenetos P, O Neill DK, et al. Satisfaction with epidural and intravenous patient-controlled analgesia. Pain Med. 2001 2 280-286. 

Macintyre PE. Intravenous patient-controlled analgesia one size does not fit all. Anesthesiol Clin North America. 2005 23 109-123. 

Maxwell LG, Kaufmann SC, Bitzer S, et al. The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia a double-blind, prospective, randomized, controlled study. Anesth Analg. 2005 100 953-958. 

Yavuz L, Eroglu F, Ozsoy M. The efficacy of intravenous versus epidural tramadol with patient-controlled analgesia (PCA) in gynecologic cancer pain. EurJ Gynaecol Oncol. 2004 25 215-218. 

Figure 3.4 Patient-controlled analgesia, or PCA (illustrated here) allows a patient to control his or her own dosing of a pain relieving medication—to an extent. When the patient presses a button, the drug is delivered through an intravenous (IV) needle. The doctor can decide how much of the drug should be delivered in each dose and how many doses a patient may have within a prescribed time period. The device will lock after that limit is reached, preventing the patient from overdosing.

Sinatra, R. (2005), The fentanyl FI Cl patient-controlled transdermal system (PCTS) An alternative to intravenous patient-controlled analgesia in the postoperative setting, Clin. Pharmacokinet., 44(Suppl 1), 1-6. 

Improve the safety of using infusion pumps, such as ensuring free-flow protection on all general-use and patient-controlled analgesia (PCA) intravenous infusion pumps used in the organization. 

Motamed C, Spencer A, Farhat F, Bourgain JL, Lasser P, Jayr C. Postoperative hypoxaemia continuous extradural infusion of bupivacaine and morphine vs patient-controlled analgesia with intravenous morphine. Br J Anaesth 1998 80(6) 742-7. 

Joshi GP, Duffy L, Chehade J, Wesevich J, Gajraj N, Johnson ER. Effects of prophylactic nalmefene on the incidence of morphine-related side effects in patients receiving intravenous patient-controlled analgesia. Anesthesiology 1999 90(4) 1007-11. 

Kampe S, Randebrock G, Kiencke P, Hunseler U, Cranfield K, Konig DP, Diefenbach C. Comparison of continuous epidural infusion of ropivacaine and sufentanil -with intravenous patient-controlled analgesia after total hip replacement. Anaesthesia 2001 56(12) 1189-93. 

Chou WY, Wang CH, Liu PH, et al. Human opioid receptor Al 18G polymorphism affects intravenous patient-controlled analgesia morphine consumption after total abdominal hysterectomy. Anesthesiology 2006 105(2) 334-7. 

Patient controlled analgesia (PCA) is a common method of administering intravenous pain medication for many patients. This will be discussed further in a subsequent chapter. 

Grond, S. Meuser, T. Zech, D. Hennig, U. Lehmann, K.A. Analgesic efficacy and safety of tramadol enantiomers in comparison with the racemate a randomised, double-blind study with gynaecological patients using intravenous patient-controlled analgesia. Pain 1995, 62, 313-320. 

A patient who underwent renal transplantation was given ciclosporin 6 mg/kg daily by intravenous infusion over 2 hours and intravenous meth-ylprednisolone postoperatively. He also received patient-controlled analgesia (PCA) as bolus doses of morphine 0.5 mg to a total dose of 13 mg on the first day and 11 mg on the second day. On the third day he developed insomnia, anxiety, amnesia, aphasia and severe confusion. The morphine was discontinued and the symptoms subsided after treatment with propofol, diazepam and haloperidol. It was suggested that ciclosporin may have decreased the excitation threshold of neuronal cells, which potentiated the dysphoric effects of morphine. ... 

Crampy pelvic pain commonly occurs within the first 24 h of UAE and is usually controlled with a patient controlled analgesia (PCA) pump using morphine or another narcotic. Patients should be placed on an anti-inflammatory prior to the embolization and while in the hospital. Toradol intravenously prior to the embolization and during the hospitalization appears to be very effective. It is reasonable to develop a set of standard orders that the patient will receive to cover the most common eventualities. 

In a web-based national survey of pain management in children, serious adverse events were associated with intravenous patient-controlled analgesia, with a response rate of 41% (294 of 724 practitioners) [59. Patient deaths and administration of naloxone to counteract cardiopulmonary adverse reactions were reported by 42 respondents. 

Ketamine-I-morphine has been compared with morphine in intravenous patient-controlled analgesia [132 ]. In seven studies there were higher frequencies of adverse reactions (including nausea, pruritus, sleepiness, desaturation, and urinary retention) when morphine was used alone four studies did not report any difference. 

Comparative studies Butorphanol 4 micro-grams/kg/hour as intravenous patient-controlled analgesia was as effective and safe as fentanyl 0.4 micrograms/kg/hour in the relief of moderate postoperative pain... 

Nelson KL, Vaster M, Kost-Byerly S, Monitto CL. A national survey of American pediatric anesthesiologists patient-controlled analgesia and other intravenous opioid therapies in pediatric acute pain management. Anesth Analg 2010 110(3) 754-60. 

Carstensen M, Moller AM. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain a qualitative review of randomized trials. Br J Anaesth 2010 104(4) 401-6. 

Thakore B, D Mello J, Saksena S, Butani M. Comparison of fentanyl and butorphanol for postoperative pain relief with intravenous patient controlled analgesia. Acute Pain 2009 11 93-9. 

Hankin CS, Schein J, Clark JA, Panchal S. Adverse events involving intravenous patient-controlled analgesia. Am J Health Syst Pharm 2007 64(14) 1492-1499. 

Ashbum MA, Love G, Pace NL. Respiratory-related critical events with intravenous patient-controlled analgesia. Clin J Pain 1994 10 52-56. 

Hydromorphone 0.2 mg/mL intravenously is used extensively for patient-controlled analgesia (PCA) in the treatment of acute pain. A typical bolus dose is 0.2 mg with a lock-out period of 6 minutes. When used on an as-needed basis hydromorphone is given at a dose of 1-2 mg every 4-6 hours. A lower initial dose should be used in opiate-naive patients. Doses can be escalated in refractory pain. Again, a decrease in the duration of pain-free periods suggests the development of tolerance to the analgesic effects of hydromorphone. Intravenous administration of hydromorphone should be slow over 2-3 minutes. 

Nalbuphine has been evaluated for use with intravenous patient-controlled analgesia. In a double-blind trial of 48 patients, nalbuphine, morphine, and pethidine (meperidine) administered with IV-PCA were compared in the first 24 hours after cholecystectomy. 

Satoh M, Hirabayashi Y, Seo N. [Intravenous patient controlled analgesia combined with continuous thoracic epidural analgesia for post-thoracotomy pain]. Masui 2000 49(11) 1222-1225. 

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