Patient Controlled Analgesia

Aka: Patient Controlled Analgesia, PCA Pump

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II. 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

III. 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

IV. 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

V. 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

VI. 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

VII. 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

VIII. References

  1. Etches (1999) Surg Clin North Am 79(2):297-312 [PubMed]

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