Analgesic
Patient Controlled Analgesia
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Patient Controlled Analgesia
, PCA Pump
See Also
Opioid
Bowel Regimen in Chronic Narcotic Use
Narcotic Overdose
Step 1
Calculate hourly dose for
Morphine
Typical Hourly
Morphine
Dose (mg/hour): (100 - age)/24
Age 30: 3 mg hourly
Morphine
dose
Age 50: 2 mg hourly
Morphine
dose
Age 70: 1.25 mg hourly
Morphine
dose
Typical hourly higher
Morphine
dose (double dose)
Age 30: 6 mg hourly
Morphine
dose
Age 50: 4 mg hourly
Morphine
dose
Age 70: 2.5 mg hourly
Morphine
dose
Step 2
Set Lockout periods and Maximums
Maximum Lockout: 20 minutes
Typical lockout period range: 6 to 12 minutes
Set one hour or four hour maximums
Example for one hour
Morphine
maximum: 10 mg
Example for four hour
Morphine
maximum: 40 mg
Step 3
Consider background infusion
Indications
Opioid Dependence
Severe pain on awakening
Calculation
Set background rate <50% of anticipated requirements
Typical adult background
Morphine
rate: 1 mg/hour
Step 4
Determine PCA bolus Dose
Bolus dose: (higher dose per hour)/(doses per hour)
For lockout at 10 minute intervals: 6 doses
Example: 30 year old with higher
Morphine
dose: 6 mg
Dose: 1 mg IV
Morphine
boluses up to q10 minutes
Step 5
Convert from
Morphine
to other medication
Hydromorphone
(
Dilaudid
) 1.5 mg per
Morphine
10 mg
Meperidine
(
Demerol
) 75 mg per
Morphine
10 mg
Examples for typical 30 year old
Morphine
Boluses: 1 mg
Background infusion rate: 1 mg/hour (optional)
Hourly maximum: 10 mg
Lockout: 6 minutes
Hydromorphone
(
Dilaudid
)
Boluses: 0.1 mg
Background infusion rate: 0.1 mg/hour (optional)
Hourly maximum: 1.5 mg
Lockout: 6 minutes
References
Etches (1999) Surg Clin North Am 79(2):297-312 [PubMed]
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