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Korean J Anesthesiol > Volume 40(2); > Article
DOI: https://doi.org/10.4097/kjae.2001.40.2.188   
Is a Basal Infusion Required in Patient-controlled Analgesia Using Fentanyl after Orthopedic Surgery?
Soon Im Kim, Sang Ho Kim, Sun Chong Kim
Department of Anesthesiology, College of Medicine, Soonchunhyang University, Seoul, Korea.
It has been suggested that addition of a basal infusion (BI) to patient-controlled analgesia (PCA) improves the continuity of analgesia for post-operative pain, by maintaining a minimum effective blood concentration of opioids between PCA demands. The aim of this study was to determine whether the addition of a BI to PCA using fentanyl would lead to improved pain control and patient satisfaction without increasing the side effects.
Seventy three patients, ASA class I or II, aged 22 - 72 years, following an orthopedic surgery under general anesthesia were studied. Patients were randomly allocated into two groups as follows: PCA group (n = 37), fentanyl 20 microgram demand dose with a lockout time of 6 min; PCA + BI group (n = 36), addition of fentanyl 20 microgram/h as a BI in the same regimen as the PCA group.
Pain scores, patient satisfaction, sedation, and incidence of side effects were similar between the two groups. However, total consumption of fentanyl during the first 24 h after surgery was significantly increased in the PCA + BI group compared with those in the PCA group (1114 +/- 334 microgram vs. 841 +/- 409 microgram, P < 0.05).
Despite the increased fentanyl consumption, the pain scores and patient satisfaction were not improved in the PCA + BI group. Addition of a BI at 20 microgram /h of fentanyl did not confer any advantage over a PCA alone and is not recommended when fentanyl PCA is used after orthopedic surgery.
Key Words: Analgesia: intravenous; patient-controlled; postoperative; Analgesics: fentanyl; Pain: measurement; postoperative
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