The Effect of Weight-Compensated Intravenous Patient-Controlled Analgesia in Burns

Kwak, In Suk; Hahm, Moonchol; Lim, Taewan

Abstract

PURPOSE
The pain related to burn is moderate to severe and difficult to control regardless of medications. We evaluated the effect of intravenous patient-controlled analgesia (IV PCA) with weight-compensated regimen of fentanyl and ketorolac in burn surgery.
METHODS
consecutive 82 patients received IV PCA after burn surgery. They were divided into two groups according to total body surface area% (TBSA%): group I (TBSA> or =25%, n=21) group II (TBSA<25%, n=61). The IV PCA consisted of fentanyl (20 mcg/kg), ketorlac (3 mg/kg), and ramoserton (8.5 mcg/kg) and was programmed to basal infusion rate 2 ml/hr, bolus rate 0.5 ml, and lockout time 15 min. Pain score and satisfaction were evaluatedduring 4 study periods within 48 hours after end of surgery: 0~6 h, 6~12 h, 12~24 h, and 24~48 h. Added recue drugs were evaluated at each interval.
RESULTS
Improvement of pain score during study periods was significant in both groups (P<0.001). However, Group I showed significantly higher VAS score than Group II. Frequency of rescue drug use was significantly higher in Group I than Group II. Improvement of satisfaction score in group II were significant (P<0.001). However, there was no significant difference in satisfaction score between two groups.
CONCLUSION
The pain of burn (TBSA> or =25%) was difficult to control by conventional IV PCA, even through weight-compensated regimen. Pain of burn (TBSA> or =25%) should be controlled by increased dose of analgesics and approaches other than conventional medication.