Patient-Controlled Analgesia

A 38-year-old female patient is 4 hours post-op following laparoscopic cholecystectomy. She is on intravenous PCA with fentanyl (10 mcg bolus, 6-minute lockout, 4-hour limit 100 mcg). She complains of nausea and has vomited once. She has pressed the PCA button only 3 times in the last hour. Her vital signs are: BP 118/76, HR 82, RR 14, SpO₂ 97% on room air. She is drowsy but arousable. What is the most appropriate next step in management?

A 52-year-old male patient is 6 hours post-op following open abdominal hysterectomy. He is on intravenous patient-controlled analgesia (PCA) with morphine (1 mg bolus, 10-minute lockout interval, 4-hour limit of 30 mg). He reports inadequate pain relief despite pressing the button frequently. His vital signs are stable (BP 128/82, HR 88, RR 16, SpO₂ 98% on room air), and he is alert and oriented. What is the most appropriate next step in management?

A 52-year-old man undergoes total abdominal hysterectomy for uterine fibroids under general anesthesia. On postoperative day 1, he is prescribed intravenous patient-controlled analgesia (IV-PCA) with morphine. The settings are: demand dose 2 mg, lockout interval 10 minutes, 4-hour limit 30 mg. At 6 hours postoperatively, the patient complains of inadequate pain relief despite pressing the button 8 times in the past hour. His respiratory rate is 18/min, oxygen saturation 96% on room air, and he is alert and oriented. What is the most appropriate next step in management?

During audit of your postoperative analgesia service, you review 200 patients who received intravenous PCA with morphine. Which is the most common reason for PCA pump lockout (demand exceeding delivery) in the first 24 hours?

A 52-year-old man with a history of chronic back pain (on long-term morphine 60 mg daily) is prescribed PCA morphine post-operatively. Regarding PCA programming in opioid-tolerant patients, all of the following are appropriate EXCEPT: