Continuous Fentanyl Background Infusion Regimen Optimised by Patient-Controlled Analgesia for Acute Postoperative Pain Management: A Randomised Controlled Trial

Abstract

Owing to a lack of studies investigating the effect of adjustments in fentanyl background infusion (BI) with patient-controlled analgesia (PCA) on postoperative analgesia, we evaluated three BI regimens with fentanyl PCA for acute postoperative pain management. This randomised controlled trial enrolled 105 patients, who were assigned to three parallel groups: constant rate BI of 2 mL/h (CRBI group); time-scheduled decremental BI of 6, 2 and 1 mL/h (TDBI group); and BI rates optimised to the demand of PCA (POBI group). The incidence of insufficient analgesia, visual analogue scale (VAS) pain score and side effects were evaluated. The incidence of insufficient analgesia in the post-anaesthesia care unit was lower in the TDBI and POBI groups than the CRBI group. Incidence of insufficient analgesia in the ward was lower in the POBI group than the CRBI group. Postoperative VAS scores were significantly lower in the TDBI and POBI groups for up to 4 h and 24 h, respectively, compared with the CRBI group. Side effects and infused fentanyl dose were highest in the CRBI group. Adjusting BI rate based on time or patient demands could improve postoperative analgesia and reduce side effects. Compared to a constant BI rate, PCA-optimised BI achieved higher patient satisfaction.

<p>Effect of Fentanyl-Based Intravenous Patient-Controlled Analgesia with and without Basal Infusion on Postoperative Opioid Consumption and Opioid-Related Side Effects: A Retrospective Cohort Study</p>

“…1 Nonetheless, IV-PCA with basal fentanyl infusion is still used. [12][13][14][15] Most of the evidence regarding this issue has been deduced from morphine-based IV-PCA in studies that included a relatively small number of patients. [8][9][10] Due to the different pharmacokinetic properties of fentanyl, evidence of the risks and benefits of basal infusion in fentanyl-based IV-PCA is required.…”

Intravenous patient-controlled analgesia regimen in postoperative pain management following elective cesarean section: A single-center retrospective evaluation

“…[ 1 ] Fentanyl, a short-acting opioid, is suitable as a demand dose of IVA due to its fast onset; however, its offset is also fast, and the need for a basal dose has been suggested for appropriate pain relief. [ 14 ] Recently, Hwang et al [ 20 ] indicated that the application of an infusion device for fentanyl PCA programmed to automatically increase or decrease the baseline dose according to the patient’s needs is more effective in managing postoperative pain on an individual basis. However, similar to the results of morphine PCA studies, fentanyl PCA has also been found to increase fentanyl consumption and opioid-induced side effects when continuous infusion is initiated.…”

Microbiological and Physicochemical Stability of Fentanyl, Oxycodone, Hydromorphone, Ketorolac, Ramosetron, and Ondansetron for Intravenous Patient-controlled Analgesia: An In Vitro Study

“…On combining fentanyl, which has a rapid onset time and short duration of action, with oxycodone or hydromorphone-opioids with a slower onset time but a longer duration of action-we can provide analgesia with a rapid onset time and long duration of action. In addition, to reduce the possibility of respiratory depression owing to the use of 2 opioids, we used a lower hourly dose than that commonly used during PCA (hourly dose of opioids in PCA in our hospital and this study: fentanyl, 0.008 mg/h; hydromorphone, 0.04 mg/h; and oxycodone, 0.2 mg/h vs commonly used opioid doses per hour during PCA: fentanyl, 0.015-0.060 mg/h (29)(30)(31); hydromorphone, 0.24-0.26 mg/h (32,33); and oxycodone, 0.3-1.2 mg/h (34)).…”