PATIENT-CONTROLLED ANALGESIA - FENTANYL R EQUIREMENTS IN BURN PATIENTS AT ACUTE-PHASE

This study assessed over the first post-burn week the patients' demand s for opiates delivered with a PCA device, changes in opioid delivery along the day, especially during painful events and the incidence bf s ide 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 P CA device during the first 6 days post burn. Bolus dose was fixed at 1 mu g.kg(-1) lock-out time at 30 min and the 4 h limit dose at 7 mu g. kg(-1). The following data were collected every day: satisfied and non -satisfied demands, total daily dose, demands during and after dressin g change period (4 h), during afternoon (10 h) and overnight periods ( 10 h). Heart rate (HR), respiratory rate (RR), blood pressure (BP), Pa co(2) and Spo(2) were also monitored. The mean total daily demands wer e similar from D1 to D6 (28 +/- 7). Around 7 demands/day were not sati sfied. 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 s atisfied ones). Mean fentanyl delivery was 1,7 +/- 0,1 mu g.kg(-1).h(- 1) during dressing period, 0,9 +/- 0,3 mu g.kg(-1).h(-1) during aftern oon period (10 h) and 0,5 +/- 0,2 during overnight period (10 h). No-s atisfied demands were around 4 boluses during dressing change period, 2 boluses during afternoon period, and one bolus during overnight peri od. Neither HR nor BP were modified for more than 20 % of control valu es; RR never decreased under 12 c.min(-1) and Paco(2) remained unchang ed. This study showed that the provision of analgesia in burn injury r equires large doses of opioids. Individual demands are scattered over a wide range. The need for analgesics remains unchanged for several da ys. A PCA device is an efficient and safe tool for administration of o pioids. Analgesia is appropriate, except during the dressing period.