IV – PCA Transition

Post Op Patient Requiring < 30mg IV Morphine in 24 hrs

 

Consider short-acting opioid given around-the-clock, for example:

Lorcet  (10/650) one tablet PO every 4 hours, patient may refuse.

 

Consider a bowel regimen and other co-analgesics to improve pain.

 

Post Op Patient Requiring >30mg IV Morphine in 24 hrs

Consider long-acting opioid based upon 50% of calculated oral morphine equivalents.  Divide this amount into BID or TID dosing.

 

Provide a short-acting opioid for breakthrough pain as described below.

 

Reduce the long-acting opioid as healing occurs and pain lessens.

 

Consider bowel regimen and other co-analgesics to improve pain.

 

Cancer Pain Patient or Chronic Non-Cancer Pain Patient

Treat patient with IV-PCA for 24-48 hours to learn the daily requirement to satisfactorily control pain.

 

Convert 24-hour IV total into oral morphine equivalents.

 

Consider a scheduled, long-acting oral opioid based upon 2/3 the calculated amount.

 

Provide a short-acting opioid for breakthrough pain as described below.

 

Consider bowel regimen and other co-analgesics to improve pain.

 

Calculating an Adequate PRN Dose: Breakthrough Pain

 

Calculate 10% of the total IV-PCA daily requirement

 

Provide a short-acting oral analgesic equal to 10% of the 24-hour total of oral morphine equivalents.  Provide this amount every 2-4 hours PRN breakthrough pain.

 

If patient experiences more than 3 episodes of breakthrough pain a day, reassess the clinical situation and determine the reason.  Consider increasing the long-acting opioid to reduce breakthrough episodes.

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