Perioperative Medicine  |   January 2016
Patient-controlled Analgesia with Target-controlled Infusion of Hydromorphone in Postoperative Pain Therapy
Author Notes
  • From the Department of Anesthesiology, University of Erlangen-Nuremberg, Erlangen, Germany. Current affiliation: Department of Anesthesiology and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland (T.I.S.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication September 15, 2014. Accepted for publication September 17, 2015.
    Submitted for publication September 15, 2014. Accepted for publication September 17, 2015.×
  • Deceased.
    Deceased.×
  • Address correspondence to Dr. Jeleazcov: Anästhesiologische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany. christian.jeleazcov@kfa.imed.uni-erlangen.de. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Pain Medicine / Pharmacology
Perioperative Medicine   |   January 2016
Patient-controlled Analgesia with Target-controlled Infusion of Hydromorphone in Postoperative Pain Therapy
Anesthesiology 1 2016, Vol.124, 56-68. doi:10.1097/ALN.0000000000000937
Anesthesiology 1 2016, Vol.124, 56-68. doi:10.1097/ALN.0000000000000937
Abstract

Background: Patient-controlled analgesia (PCA) is a common method for postoperative pain therapy, but it is characterized by large variation of plasma concentrations. PCA with target-controlled infusion (TCI-PCA) may be an alternative. In a previous analysis, the authors developed a pharmacokinetic model for hydromorphone. In this secondary analysis, the authors investigated the feasibility and efficacy of TCI-PCA for postoperative pain therapy with hydromorphone.

Methods: Fifty adult patients undergoing cardiac surgery were enrolled in this study. Postoperatively, hydromorphone was applied intravenously during three sequential periods: (1) as TCI with plasma target concentrations of 1 to 2 ng/ml until extubation; (2) as TCI-PCA with plasma target concentrations between 0.8 and 10 ng/ml during the following 6 to 8 h; and (3) thereafter as PCA with a bolus dose of 0.2 mg until the next morning. During TCI-PCA, pain was regularly assessed using the 11-point numerical rating scale (NRS). A pharmacokinetic/pharmacodynamic model was developed using ordinal logistic regression based on measured plasma concentrations.

Results: Data of 43 patients aged 40 to 81 yr were analyzed. The hydromorphone dose during TCI-PCA was 0.26 mg/h (0.07 to 0.93 mg/h). The maximum plasma target concentration during TCI-PCA was 2.3 ng/ml (0.9 to 7.0 ng/ml). The NRS score under deep inspiration was less than 5 in 83% of the ratings. Nausea was present in 30%, vomiting in 9%, and respiratory insufficiency in 5% of the patients. The EC50 of hydromorphone for NRS of 4 or less was 4.1 ng/ml (0.6 to 12.8 ng/ml).

Conclusion: TCI-PCA with hydromorphone offered satisfactory postoperative pain therapy with moderate side effects.

Abstract

Using hydromorphone-specific pharmacokinetic parameters, accurate target-controlled infusions can be delivered. Using combined target-controlled infusion with patient-controlled analgesia, satisfactory postoperative pain control can be delivered with moderate levels of opioid-related side effects.

Supplemental Digital Content is available in the text.