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Patient Controlled Analgesia
Aka: 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]