Patientcontrolled analgesia

Patient-controlled analgesia minimizes interpatient pharmacokinetic and pharmacodynamic variability to allow suitable patients to titrate a predetermined bolus of opioid against their pain (Baljantyne. etal 1993). The dose, lockout period, and bolus infusion period are set by the practitioner. Most patients experience an individually determined satisfactory level of analgesia. Usage is significantly influenced by factors such as mood, anxiety, and expectation of recovery. Patient-controlled analgesia should not be used if the negative feedback loop is not intact. A maximum limit of half the predicted hourly rate may be used if an infusion combined with patient-controlled analgesia is desired. Meperidine (pethidine) may be used for periods of 2 to 3 days, but prolonged use is associated with dysphoria and accumulation of normeperidine (norpethidine) with a risk of convulsions.

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