[Patient-controlled analgesia: a study of fentanyl requirements in burnt patients during the acute phase]

This study assessed over the first post-burn week the patients' demands for opiates delivered with a PCA device, changes in opioid delivery along the day, especially during painful events and the incidence of side effects. Twenty-two patients (8 women, 14 men), mean age 33 years (+/- 12 SD), mean BSA 21% (+/- 13 SD), mean deep dermal burn 12% (+/- 11 SD) were included. Fentanyl was delivered by i.v. route using a PCA device during the first 6 days post burn. Bolus dose was fixed at 1 microgram.kg-1, lock-out time at 30 min and the 4 h limit dose at 7 micrograms.kg-1. The following data were collected every day: satisfied and non-satisfied demands, total daily dose, demands during and after dressing change period (4 h), during afternoon (10 h) and overnight periods (10 h). Heart rate (HR), respiratory rate (RR), blood pressure (BP), Paco2 and Spo2 were also monitored. The mean total daily demands were similar from D1 to D6 (28 +/- 7). Around 7 demands/day were not satisfied. The mean total daily satisfied demands were also the same: 21 +/- 5. Individual demands were over a wide range (minimum: 15, maximum: 41 demands/day for total demands and 13 and 34 respectively for the satisfied ones). Mean fentanyl delivery was 1.7 +/- 0.1 microgram.kg-1.h-1 during dressing period, 0.9 +/- 0.3 microgram.kg-1.h-1 during afternoon period (10 h) and 0.5 +/- 0.2 during overnight period (10 h). No-satisfied demands were around 4 boluses during dressing change period, 2 boluses during afternoon period, and one bolus during overnight period.(ABSTRACT TRUNCATED AT 250 WORDS)