Patient-controlled analgesia (PCA): Additions or Alternatives to Morphine

Intravenous patient-controlled analgesia (PCA) is frequently used as a means of easing postoperative pain. Morphine is the most commonly used opiate, but some patients have allergies or experience side effects, requiring the use of alternatives. Meperidine is not the best choice. It is associated with normeperidine intoxication and, if used, both the dosages and duration of administration should be limited. Hydromorphone, fentanyl and sufentanil have all been used successfully. It is recommended that alfentanil be administered by continuous infusion because it is short-acting. In comparison, none of the opiates proved to be significantly superior to the others. Morphine has been combined with ketamine, clonidine, and droperidol with mixed results, but the optimal dose of each combination is still unknown. The alfentanil-propofol combination looks promising for sedation during certain procedures.

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