• Christian Jeleazcov, Harald Ihmsen, Teijo I Saari, Doris Rohde, Jan Mell, Katharina Fröhlich, Ljubica Krajinovic, Jörg Fechner, Helmut Schwilden, and Jürgen Schüttler.
• From the Department of Anesthesiology, University of Erlangen-Nuremberg, Erlangen, Germany. Current affiliation: Department of Anesthesiology and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland (T.I.S.).
• Anesthesiology. 2016 Jan 1;124(1):56-68.

BackgroundPatient-controlled analgesia (PCA) is a common method for postoperative pain therapy, but it is characterized by large variation of plasma concentrations. PCA with target-controlled infusion (TCI-PCA) may be an alternative. In a previous analysis, the authors developed a pharmacokinetic model for hydromorphone. In this secondary analysis, the authors investigated the feasibility and efficacy of TCI-PCA for postoperative pain therapy with hydromorphone.MethodsFifty adult patients undergoing cardiac surgery were enrolled in this study. Postoperatively, hydromorphone was applied intravenously during three sequential periods: (1) as TCI with plasma target concentrations of 1 to 2 ng/ml until extubation; (2) as TCI-PCA with plasma target concentrations between 0.8 and 10 ng/ml during the following 6 to 8 h; and (3) thereafter as PCA with a bolus dose of 0.2 mg until the next morning. During TCI-PCA, pain was regularly assessed using the 11-point numerical rating scale (NRS). A pharmacokinetic/pharmacodynamic model was developed using ordinal logistic regression based on measured plasma concentrations.ResultsData of 43 patients aged 40 to 81 yr were analyzed. The hydromorphone dose during TCI-PCA was 0.26 mg/h (0.07 to 0.93 mg/h). The maximum plasma target concentration during TCI-PCA was 2.3 ng/ml (0.9 to 7.0 ng/ml). The NRS score under deep inspiration was less than 5 in 83% of the ratings. Nausea was present in 30%, vomiting in 9%, and respiratory insufficiency in 5% of the patients. The EC50 of hydromorphone for NRS of 4 or less was 4.1 ng/ml (0.6 to 12.8 ng/ml).ConclusionTCI-PCA with hydromorphone offered satisfactory postoperative pain therapy with moderate side effects.

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