PATIENT CONTROLLED ANALGESIA
“This protocol is sourced from MRHM and has been accurately reproduced for research and audit purposes only. It is not intended for clinical application. Users are fully responsible for any use of this document.”
Make sure you are familiar with the set up of our locked infusion pumps (CADD-PRIZM PCS II). PCA is recommended for children of 5 years and over in whom moderate to severe pain is anticipated for 24 hours or more.
The child should be instructed in the use of PCA prior to coming to theatre or even in the anaesthetic room before induction.
Standart Hospital Formula
Morphine 2 mg/kg added to Dextrose 5% w/v or 0.9% saline to make a total volume of 50 ml (Can use 1mg/kg in 25 ml volume)
1 ml = 40 microgram/kg
Maximum concentration: 100mg/50ml (Prefilled adult cartridge for > 50kg child)
PROGRAMMING PUMP
| Loading Dose | 80-120microgram/kg | Administered by anaesthetist |
| PCA bolus | 0.5 ml Range: 0.5-1ml | (20-40 microgram/kg) or 1mg in children > 50 kg |
| Lockout | 6 minutes | Range: 5-12min |
| Continous Infusion | 0.5ml/hr Range:0-1 ml/ hr | (0-40-microgram/kg/hr) or 1-2 mg /hr in children > 50 kg |
| Maximum Dose Limit | < 50 kg) (400 microgram/kg ml over 4 hours (10 ml) | > 50 kg, 20 mgs over 4 hours (10ml) |
GENERAL INSTRUCTIONS
- No Supplementary opiates unless prescribed by Anaesthetist
- Anti siphon valve must be used with all IV opioid infusions
- Line for IV opiates should be exclusive or an anti-reflux valve must be used
- Maintain IV access during pain management.
- Record observations according to the following guidelines
- One hourly for 4 hours then 4 hourly
- Resp rate, HR, BP, Temp, Pain/Nausea/Sedation score
- If scores are zero for two observations can monitor six hourly
- Use regular Non-sedating analgesics
- NSAID Difene 1mg/kg PR 12 hourly or Brufen 8 mg/kg TID orally
- Paracetamol 15 mg/kg PR or PO or IV
- Treatment of:
Inadequate analgesia Call Anaesthetist (bleep 097)
Nausea and Vomiting Antiemetics
Cyclizine 1 mg/kg (max 50)
Ondensetron 0.1 mg/kg (max 4)
Itching Piriton (0.2mg/kg max 10mg)
Urinary Retention Consider in and out catheter
Over Sedation (Unrousable) Stop PCA call anaesthetist
Consider Naloxone
Respiratory Depression If respiratory Rate is less than 8/min Administer 02
Administer O2
Naloxone 8 μg/kg i/m
Call Aanesthetist (bleep 097) - Patient Review:
Each child should be reviewed by anaesthetist carrying bleep 097 next day and on PCA disconnection. The review of pain score, sedation score, and nausea vomiting score, drug volume usage and overall patient/parent satisfaction must be recorded in PCA audit book.
| TERMINOLOGY | DEFINITION |
|---|---|
| Loading Dose | A loading dose can be administered to patients prior to the commencement of PCA. This ensures the patient’s pain is relieved to an acceptable level; PCA can then be commenced in order to maintain adequate analgesia. |
| Bolus Dose | Is the amount of drug the patient receives when the handset or demand button is pressed |
| Dose Duration | Refers to the amount of time that the Device will deliver each bolus dose over. |
| Lockout Period | The time from the end of delivery of one successful bolus until the machine will allow the patient to receive another bolus |
| Demands/Good Demands | Each time the handset is activated the device will record this as a demand, each time the patient presses the handset and receives a bolus this will be recorded as a Good Demand. |
| Background Infusion | A continuous infusion that can be added to provide a more steady blood concentration of analgesic. |
| Hourly or Four Hourly Limit | Prevents the patient receiving more than an identified amount of opioid over a given time period. |
| Total Amount Of Drug | Electronic devices record the total amount of drug a patient has received since the device was reset. This includes all bolus doses and a background infusion if this is prescribed. |
Baseline 100mg/50ml prefilled CADD
Want con. of 40µg/kg/ml morphine
Bolus = 0.5ml = 20µg/kg
2mg/kg in 50 ml
= 40 µg/kg/ml
MAKE UP:
Wt(kg) X 2 in 50ml
Want (47kg) = 94mg in 50ml
Now have 100 in 50
removing 6mg = 3ml = leaves 47ml
replace with 0.9% NaCl 3ml
==> 96mg in 50ml
SAY 30kg -> want 60mg in 50
remove 40mg = 20ml
replace 20mls with Saline
CADD-PrizmTM PCS II Official Operators Manual
Last updated on 09/19/2024
