Patient Controlled Analgesia Titration

How to Titrate:

 • Opioid Naive: No basal rate

 • Chronic Opioid Use: Set the basal rate at equianalgesic dose of chronic opioid

Parameters:

 • Calculate basal rate (if needed)

 • Incremental dose: 50-100% of basal rate

 • Lockout: 8 to 10 minutes (6 minutes for fentanyl)

 • Loading: Twice the incremental dose (10% of 24-hour dose)

Adjustments:

 • Can change incremental dose every 30-60 minutes (great for acute pain, and rapid titrations)

 • Mild to moderate pain: increase dose 25-50%

 • Moderate to severe pain: increase dose 50-100%

 • Change basal rate every 8 hours as needed (but don't change more than 100% at a time)



- Dr. Kevin Braghirol @KBrag_MD



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