This PCA regimen should be used after achieving adequate pain control in the acute postoperative period. Initial postoperative pain control should be performed in a monitored setting such as the PACU or ICU. IV opioids may be used for initial pain control if titrated carefully to analgesic effect while monitoring respiration and oxygenation. For example, hydromorphone may be administered by a PACU nurse from 0.1 to 0.4 mg IV bolus every 5 to 10 minutes until adequate analgesia before initiating PCA.
Dosing should be individualized according to patient-specific factors, clinical situation, comorbidities, and concurrent medications. Lower doses and continuous pulse oximetry and end-tidal carbon dioxide monitoring are recommended during the early postoperative period, in older adults, and in patients with increased risk for respiratory depression, hypoxia, and/or opioid accumulation (eg, due to obstructive airway disease, sleep apnea, obesity, low body weight, frailty, renal and/or hepatic impairment, or use with other medications with sedating and/or respiratory depressant properties).
The use of a continuous infusion (basal opioid infusion) is not recommended in patients who are not mechanically-ventilated.
PCA dose ranges and other details shown in the table are suggestions only; protocols will vary by institution. For additional detail, refer to the individual Lexicomp drug information monographs included with UpToDate.
PACU: Postanesthesia care unit; ICU: Intensive care unit; IV: intravenous.
