A good book that the Pain department should have is Neural Blockade in Clinical Anesthesia and Management of Pain by Cousins. In the book, you'll find PCIA & PCEA dosing guidelines as well as an algorithm for assessing and treating inadequate epidural analgesia. Common PCA dosing at one of our institutions is Morphine (1mg/cc) 0.5-2.0/6 min lockout/basal of 1-10; Dilaudid (0.5mg/cc) 0.2-1cc/10/0.2-0.5; and Demerol (10mg/cc) 1-1.5cc/10/none. Different institutions have different beliefs and approaches with regards to basal infusion rates and nighttime basal infusion. There's isn't any one best answer and a lot of it is just titration and watching for side effects and complications. A standard mix frequently used here for epidural analgesia is Bupivacaine 0.1%/Dilaudid 20 mcg/cc. The usual rate is 2-12 ml/hr.
An important part of PCIA and epidural management is anticipating and managing potential side effects and complications. Common side effects depending on route include n/v, pruritis, parathesias, urinary retention, sedation, hypotension, etc. Complications to look for include epidural hematoma, abscess, subdural puncture, catheter migration, etc.
Before you remove the catheter in an anticoagulated patient, be sure to follow guidelines at your hospital. You'll need to wait a certain number of hours after anticoagulation before removing the catheter. A
narcotic conversion calculator will help you determine the equianalgesic dosage of PO medications that you might eventually switch them to.
In terms of online resources, there aren't that many, but try
this chapter,
UCLA's website, and
University of Wisconsin's website.
