Use of patient-controlled analgesia with alfentanil for burns dressing procedures: a preliminary report of five patients

Sim, Kah Ming; Hwang, Nian Chih; Chan, Yau-Chi; Seah, C. S.

doi:10.1016/0305-4179(95)00121-2

Cited by 26 publications

(10 citation statements)

References 22 publications

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“…Pain intensity was assessed by the VAS score. The sedation score was recorded (1 ϭ awake, 2 ϭ mildly sedated, or 3 ϭ cannot be aroused) (2). After the procedure, heart rate, arterial blood pressure, respiratory rate, and Spo 2 were recorded every 15 min for 2 h. Nausea, vomiting, or any other adverse effects were noted.…”

Section: Methodsmentioning

confidence: 99%

“…Very often the analgesia provided by these regimens is inadequate (2). Patientcontrolled analgesia (PCA) allows patients to selfadminister small predetermined doses of analgesic medication within limits prescribed by their physician (5), resulting in improved pain relief, avoidance of over-and undermedication, and greater patient satisfaction (2). PCA with a potent, rapid onset and a relatively short-acting opioid such as fentanyl offers a method of providing pain relief during burn dressing changes.…”

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confidence: 99%

“…Burn pain, in particular, is one of the most severe forms of acute pain experienced by patients (1). It consists of a constant background pain of relatively low intensity on which are superimposed short-lasting peaks of severe to excruciating pain during therapeutic procedures such as dressing changes and physiotherapy (2). Procedure-related pain requires frequent assessment and individual titration for effective pain management (3).…”

mentioning

confidence: 99%

“…Conventionally, large doses of potent opioids are delivered either by repeated IM or IV injections to alleviate procedure-related pain. Very often the analgesia provided by these regimens is inadequate (2). Patientcontrolled analgesia (PCA) allows patients to selfadminister small predetermined doses of analgesic medication within limits prescribed by their physician (5), resulting in improved pain relief, avoidance of over-and undermedication, and greater patient satisfaction (2).…”

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confidence: 99%

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Patient-Controlled Analgesia with Fentanyl for Burn Dressing Changes

Prakash

Fatima

Pawar

2004

Anesthesia & Analgesia

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In this randomized, double-blinded study in 60 ASA I or II adults with >20% body-surface area thermal burns, we investigated the feasibility of patient-controlled analgesia (PCA) with fentanyl for pain management during dressing changes and determined the optimal PCA-fentanyl demand dose. An initial loading dose of IV fentanyl 1 microg/kg was administered. Patients received on-demand analgesia with fentanyl (10, 20, 30, and 40 microg) whenever their visual analog scale (VAS) score was >2. Mean VAS scores in the 10 and 20 microg groups (7.73 +/- 1.33 and 7.20 +/- 1.21, respectively) were significantly higher than those in the 30 and 40 microg groups (4.47 +/- 0.83 and 3.90 +/- 0.63, respectively) (all P = 0.000). Demand/delivery ratios were significantly larger in the 10 and 20 microg groups (3.03 +/- 1.06 and 2.54 +/- 0.49, respectively) than those in the 30 and 40 microg groups (1.36 +/- 0.34 and 1.37 +/- 0.36, respectively) (all P = 0.000). VAS scores and demand/delivery ratios were comparable in the 30 and 40 microg groups (P = 0.260 and P = 0.977, respectively), which suggests comparable analgesic efficacy. There was no hemodynamic instability or respiratory depression. The optimal demand dose of PCA-fentanyl was 30 microg (5-min lockout interval) after an initial loading dose of IV fentanyl 1 microg/kg.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Patient-Controlled Analgesia with Fentanyl for Burn Dressing Changes

Prakash

Fatima

Pawar

2004

Anesthesia & Analgesia

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“…Level II) or alfentanil (Sim et al, 1996 Level IV) administered via PCA or target-controlled infusions (Gallagher, Rae, Kenny et al, 2000 Level IV) have been used successfully to provide analgesia during burn dressing changes. IN fentanyl was a viable alternative to oral morphine in children for burn dressings Level II).…”

Section: Short-acting Opioids Such As Fentanyl (Prakash Et Al 2004mentioning

confidence: 99%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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Intravenous Drugs for Sedation: Target-Controlled, Patient-Controlled and Patient-Maintained Delivery

Anderson

2017

Total Intravenous Anesthesia and Target Controlled Infusions

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Use of patient-controlled analgesia with alfentanil for burns dressing procedures: a preliminary report of five patients

Cited by 26 publications

References 22 publications

Patient-Controlled Analgesia with Fentanyl for Burn Dressing Changes

Patient-Controlled Analgesia with Fentanyl for Burn Dressing Changes

Safety of opioid patch initiation in Australian residential aged care

Intravenous Drugs for Sedation: Target-Controlled, Patient-Controlled and Patient-Maintained Delivery

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