Continuous IV Infusion (Analgesic)
A 63 year old Indian lady with a soft tissue sarcoma around the right hip was admitted to the wards for management of her pain. She had previously on oral analgesics but pain has become unbearable and not controlled by current therapeutic regimens. She was a relatively well nourished woman weighing about 47kg. She was in pain, but other than the mass around her hip and mild dehydration she was relatively well. Clinical biochemistry showed mild liver impairment. Renal function was normal.
You decide to start her on a 1.5 mg per hour infusion of an opioid analgesic. This opioid is highly lipophilic and primarily eliminated by hepatic metabolism. There is a possibility that some metabolites may be pharmacologically active and may contribute to both the pain relief and central nervous system depression.
Analgesic requirements vary considerably between individuals, but minimum effective analgesic concentrations (MEAC) generally fall between 0.01mg/L to 0.05 mg/L. For many patients, concentrations about 50% greater than the MEAC are associated with increasing amounts of drowsiness and serious respiratory depression.
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