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. 2014 May;55(3):800-6.
doi: 10.3349/ymj.2014.55.3.800. Epub 2014 Apr 1.

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

Seokyung Shin  1 , Keoung Tae Min  1 , Yang Sik Shin  1 , Hyung Min Joo  2 , Young Chul Yoo  1
Affiliations

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

Seokyung Shin et al. Yonsei Med J. 2014 May.

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.

Keywords: Analgesia; adjuvant drug; background infusion rate; fentanyl; patient-controlled.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart for patient sample selection. ICU, intensive care unit.
See this image and copyright information in PMC

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