Yonsei Med J.  2014 May;55(3):800-806. 10.3349/ymj.2014.55.3.800.

Finding the 'Ideal' Regimen for Fentanyl-Based Intravenous Patient-Controlled Analgesia: How to Give and What to Mix?

• Shin S
• Min KT
• Shin YS
• Joo HM
• Yoo YC

• KMID: 2068694
• DOI: http://doi.org/10.3349/ymj.2014.55.3.800

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.

Keyword

Analgesia; patient-controlled; fentanyl; background infusion rate; adjuvant drug

MeSH Terms

Adult
Aged
Analgesia, Patient-Controlled/*adverse effects/*methods
Female
Fentanyl/administration & dosage/therapeutic use
Humans
Male
Middle Aged
Retrospective Studies
Sex Factors
Fentanyl

Figure

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  Fig. 1 Flowchart for patient sample selection. ICU, intensive care unit.

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