Patient-Controlled Analgesia (PCA) with Fentanyl for Dressing Changes in Burn Patients

Abstract

To evaluate different regimens of intravenous PCA fentanyl for dressing change-related pain in burn patients 60 dressing changes among 20 burn patients were studied. They were randomly separated into three groups. Gr.Ⅰ: initial placebo dose, PCA setting with bolus dose, fentanyl 1μg/kg; lock-out time 30 min. Gr.Ⅱ: initial fentanyl dose 2μg/kg, PCA setting with bolus dose, fentanyl 1μg/kg; lock-out time 30 min. Gr. Ⅲ: initial fentanyl dose 2μg/kg, PCA setting with bolus dose, fentanyl 1μg/kg; lockout time 5 min. Surgeons performing the procedures and the patients were blind to the regimen being used. Surgeons could give rescue doses of fentanyl 1μg/kg /per dose freely. We recorded the fentanyl requirement, Visual Analogue Pain Score, Fail trial, and Satisfaction Score before the procedure, during the procedure, and until 4 hours after the end of procedure. The results showed that the Visual Analogue Pain Score during procedure (VAS-P) in Gr.Ⅲ was lowest (p＜0.05) (Gr.Ⅰ: 5.9±2.13, Gr.Ⅱ: 4.88±2.13, Gr. Ⅲ: 3.12±1.98). The satisfaction of pain relief during procedure was best in Gr. Ⅲ (p＜0.05) (Gr.Ⅰ: 2.8±0.89, Gr.Ⅱ: 3.1±1.12, Gr. Ⅲ: 3.7±0.98). There were no rescue doses given in Gr. Ⅲ. The total fentanyl requirement during the procedure was the highest in Gr. Ⅲ. (p＜0.05) (Gr.Ⅰ:1.95±1.00,μg/kg Gr. Ⅱ:2.55±0.76μg/kg, Gr. Ⅲ: 3.90±1.37μg/kg). There were no difference in VAS, satisfaction score, dose requirement, and fail trial during the four hours after the end of procedures. No complications were noted. In conclusion, fentanyl PCA setting with an initial dose of 2μg/kg, and a PCA bolus does of 1μg/kg, with a lock-out time of 5 min is an effective and safe way to handle the procedural pain during dressing change in burn patients. After the procedure is completed, all three regimens studied are equally effective in treating burn pain.