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Finding the 'ideal' regimen for fentanyl-based intravenous patient-controlled analgesia: how to give and what to mix?

 Seokyung Shin  ;  Keoung Tae Min  ;  Yang Sik Shin  ;  Hyung Min Joo  ;  Young Chul Yoo 
 YONSEI MEDICAL JOURNAL, Vol.55(3) : 800-806, 2014 
Journal Title
Issue Date
Adult ; Aged ; Analgesia, Patient-Controlled/adverse effects* ; Analgesia, Patient-Controlled/methods* ; Female ; Fentanyl/administration & dosage ; Fentanyl/therapeutic use ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sex Factors
Analgesia ; adjuvant drug ; background infusion rate ; fentanyl ; patient-controlled
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 μg/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 μg/kg/hr (AUC 0.712) or lower. A background infusion rate of 0.36 μg/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 μg/kg/hr (AUC 0.651) or higher. CONCLUSION: Background infusion rates of fentanyl between 0.12 and 0.67 μg/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.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Min, Kyeong Tae(민경태) ORCID logo https://orcid.org/0000-0002-3299-4500
Shin, Seokyung(신서경) ORCID logo https://orcid.org/0000-0002-2641-0070
Shin, Yang Sik(신양식)
Yoo, Young Chul(유영철) ORCID logo https://orcid.org/0000-0002-6334-7541
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