PCA basal infusion and ped pts

Basic, Clinical Sciences: Anesthesia Procedures, Methods, and Techniques, Pain

PCA can be an effective way of managing post-operative pain for children with appropriate level of understanding (generally age 6 and above without developmental delay). For children not developmentally appropriate for PCA, a PNCA (patient-nurse controlled analgesia) approach may be useful.

Using a basal infusion in conjunction with available PCA bolus doses allows for a more steady state of pain control with fewer analgesic troughs and subsequently increased pain. A basal infusion maintains therapeutic plasma opioid concentrations, decreases nocturnal awakenings due to pain, decreases total opioid consumption, and has potentially fewer side effects. Morphine is the most commonly used opioid, although fentanyl and hydromorphone can be used as well. While there may be benefits to using PCAs in age-appropriate children in the post-operative period, there is also the potential for over-sedation and the mechanism of the PCA (you can’t hit the button if you are asleep from being over narcotized) is essentially nullified by the basal infusion. This makes appropriate dosing with a “start low and go slow” approach even more critical.

PCA Dosing for Opiate Naîve Children

Drug

Bolus Dose (ug/kg)

Lockout Interval (min)

Basal infusion rate (ug/kg/hour)

4-Hour Limit (ug/kg)

Morphine

10 - 20

8 - 15

0 - 20

250 - 400

Hydromorphone

2 - 4

8 - 15

0 - 4

50 - 80

Fentanyl

0.5

5 - 10

0 - 0.5

7 - 10

90%

Answered correctly

2019

Year asked

84%

Answered correctly

2017

Year asked

88%

Answered correctly

2014

Year asked

Author
Caitlin D. Tourjé, MD