Analgesic

Patient Controlled Analgesia

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Patient Controlled Analgesia, PCA Pump

  • Step 1
  • Calculate hourly dose for Morphine
  1. Typical Hourly Morphine Dose (mg/hour): (100 - age)/24
    1. Age 30: 3 mg hourly Morphine dose
    2. Age 50: 2 mg hourly Morphine dose
    3. Age 70: 1.25 mg hourly Morphine dose
  2. Typical hourly higher Morphine dose (double dose)
    1. Age 30: 6 mg hourly Morphine dose
    2. Age 50: 4 mg hourly Morphine dose
    3. Age 70: 2.5 mg hourly Morphine dose
  • Step 2
  • Set Lockout periods and Maximums
  1. Maximum Lockout: 20 minutes
  2. Typical lockout period range: 6 to 12 minutes
  3. Set one hour or four hour maximums
    1. Example for one hour Morphine maximum: 10 mg
    2. Example for four hour Morphine maximum: 40 mg
  • Step 3
  • Consider background infusion
  1. Indications
    1. Opioid Dependence
    2. Severe pain on awakening
  2. Calculation
    1. Set background rate <50% of anticipated requirements
    2. Typical adult background Morphine rate: 1 mg/hour
  • Step 4
  • Determine PCA bolus Dose
  1. Bolus dose: (higher dose per hour)/(doses per hour)
  2. For lockout at 10 minute intervals: 6 doses
    1. Example: 30 year old with higher Morphine dose: 6 mg
    2. Dose: 1 mg IV Morphine boluses up to q10 minutes
  • Step 5
  • Convert from Morphine to other medication
  1. Hydromorphone (Dilaudid) 1.5 mg per Morphine 10 mg
  2. Meperidine (Demerol) 75 mg per Morphine 10 mg
  • Examples for typical 30 year old
  1. Morphine
    1. Boluses: 1 mg
    2. Background infusion rate: 1 mg/hour (optional)
    3. Hourly maximum: 10 mg
    4. Lockout: 6 minutes
  2. Hydromorphone (Dilaudid)
    1. Boluses: 0.1 mg
    2. Background infusion rate: 0.1 mg/hour (optional)
    3. Hourly maximum: 1.5 mg
    4. Lockout: 6 minutes