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

Authors
 Seokyung Shin  ;  Keoung Tae Min  ;  Yang Sik Shin  ;  Hyung Min Joo  ;  Young Chul Yoo 
Citation
 Yonsei Medical Journal, Vol.55(3) : 800-806, 2014 
Journal Title
 Yonsei Medical Journal 
ISSN
 0513-5796 
Issue Date
2014
MeSH
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
Keywords
Analgesia ; adjuvant drug ; background infusion rate ; fentanyl ; patient-controlled
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 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.
Files in This Item:
T201405791.pdf Download
DOI
10.3349/ymj.2014.55.3.800
Appears in Collections:
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
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/138895
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