Basal Rates in Patient Controlled Analgesia
The use of patient controlled analgesia (PCA) machines was a true advance in the care of postoperative patients. These machines allow the patient to give themselves doses of a narcotic when they are experiencing pain. The most common narcotics given out in PCA machines are morphine and fentanyl. The machines have a preset limit
on how much and how often the patient can receive their painkiller. Despite reports in the literature of the machine malfunctioning and giving the patient too much narcotic, overall PCA machines have proven to be worth the very slight risk of this happening.
One problem with PCA machines is that they can be programmed to give the patient a constant rate or basal rate of narcotic, in addition to that delivered when the patient “pushes the button”. This can be dangerous, especially in patients who are not used to receiving narcotics. A basal rate in addition to a demand amount of narcotic can cause the patient to effectively overdose and can cause respiratory depression, decreased mental status, and hypotension. Because of this most surgeons do not prescribe a basal rate to patients who are not already habituated to the narcotic.
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