title: The efficacy of the time-scheduled decremental continuous infusion of fentanyl for postoperative patient-controlled analgesia after total intravenous anesthesia.
abstract: BACKGROUND
  Intravenous fentanyl has been used for acute postoperative pain management, but has not always provided reliable adequate analgesia, including patient-controlled analgesia (PCA). The purpose of this study was to investigate the efficacy of time-scheduled decremental infusion of fentanyl for postoperative analgesia.
  
  
  METHODS
  Ninety-nine patients, aged 20-65 years, undergoing laparoscopic-assisted hysterectomy using total intravenous anesthesia (TIVA) were randomly assigned into one of the three groups. Their background infusions of fentanyl diluent (2 ml/hr of diluent was equivalent with 0.5 µg/kg/hr of fentanyl) with PCA were maintained at the fixed-rate of 2 ml/hr until the postoperative 24 hr (FX2-2-2), or at the decremental rates of 6.0, 4.0, 2.0 ml/hr (D6-4-2) and 8.0, 4.0, 2.0 ml/hr (D8-4-2). The visual analogue score (VAS), incidence of inadequate analgesia, frequency of PCA intervention, and side effects were evaluated.
  
  
  RESULTS
  VAS was significantly higher in FX2-2-2 than in D6-4-2 and D8-4-2 until postoperative 3 hr (P < 0.05). After postoperative 4 hr, VAS was significantly higher in FX2-2-2 than D8-4-2 (P < 0.05). The incidence of inadequate analgesia of FX2-2-2 was significantly greater than D6-4-2 (P = 0.038) and D8-4-2 (P < 0.001) until postoperative 1 hr. None of the patients had ventilatory depression, and postoperative nausea and vomiting were not significant among the groups.
  
  
  CONCLUSIONS
  The time-scheduled decremental background infusion regimens of fentanyl, based on the pharmacokinetic model, could provide more effective postoperative pain management after TIVA, and the side effects and the risk for morbidity were not different from the fixed-rate infusion regimen.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jong-Yeop
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Sung-Yong
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Hyuk Soo
authors.initials: HS
authors.lastname: Chang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Si-Kwon
authors.initials: SK
authors.lastname: Nam
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Sang-Kee
authors.initials: SK
authors.lastname: Min
keywords: Fentanyl; Intravenous anesthesia; Patient-controlled analgesia