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ADVANCED PHARMACOLOGY (NSG 533) OPIOID GROUP DISCUSSION 2024/2025 $12.29   Add to cart

Exam (elaborations)

ADVANCED PHARMACOLOGY (NSG 533) OPIOID GROUP DISCUSSION 2024/2025

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ADVANCED PHARMACOLOGY (NSG 533) OPIOID GROUP DISCUSSION 2024/2025

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  • October 29, 2024
  • 8
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
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ADVANCED PHARMACOLOGY (NSG 533) OPIOID GROUP DISCUSSION
2024/2025
Part 1

Based on the type of injury, what type of pain is this patient likely to experience?

It is likely that the patient will experience both nociceptive and neuropathic pain

postoperatively. Subacute postoperative pain related to wound healing always follows a limb

amputation (Larbig et al., 2019). Additionally, patients can experience phantom limb pain (PLP),

residual limb pain (RLP), and chronic pains “such as ‘mirror image’ pain in the contralateral

limb and back pain” concurrently after a limb has been amputated (Larbig et al., 2019, p. 44).

What type of pain management regimen would you suggest in the postoperative period?

Explain your answer.

Post-amputation pain (PAP) is challenging to manage, as there are multifactorial

underlying mechanisms at play. Such complexity requires a multidisciplinary care approach that

involves medical, rehabilitative, and psychiatric services (Kent et al., 2017). Ideally these

services would work congruently during the perioperative phase and a postoperative pain

treatment plan would be developed during this time. Ghai et al. (2018) offer the following

templet for the multidisciplinary care that is required during the peri and postoperative phases of

a limb amputation in efforts of reducing PLP:

• Identify patients for the prevention of PLP with detailed history taking, assessment of

pain, special attention to neuropathic pain, pain questionnaire, anxiety and depression

pain questionnaire, and neurological examination;


• Consider a team approach including the surgeon, anesthesiologist, pain physician,
physiotherapist, rehabilitation staff, and patient's caregivers;

, 2


• Perioperative epidural analgesia with adjuvants (ketamine or calcitonin or opioids) (Level

II) or IV opioid PCA (Level II) for optimized postoperative pain relief, starting 48 hours

prior to surgery to minimum up to 72 hours postoperatively;

• Include NSAIDs and paracetamol as part of multimodal analgesia;

• Psychological support and rehabilitation;

• Individualization approach regarding use of gabapentanoids as preventive strategy (p.
447).


Additional pain prevention and management options include: i) alternative surgical

techniques, ii) combining spinal epidural anesthesia with general anesthesia during surgery, iii)

perineural catheters, iv) intravenous (IV) opioid patient-controlled anesthesia (PCA), and v) IV

ketamine (Ghai et al., 2018). Despite numerous studies attempting to understand, prevent, and

manage the multifactorial pains associated with limb amputations, no one method has been

identified as superior (Ghai et al., 2018). Ghai et al. (2018) report that aggressive epidural

anesthesia and opioid PCA have been deemed as acceptable measures to prevent PLP.

Part 2

What dosing regimen would you suggest?

According to Chisholm-Burns et al. (2019), 30 mg of hydrocodone is equivalent to 10 mg

of parenteral morphine. The patient is taking 55 mg of morphine per day which would equate to

165 mg of hydrocodone per day without any adjustments for cross-tolerance and 82.5 mg of

hydrocodone per day when adjusted by 50%. I would suggest hydrocodone/APAP 10/325 mg

every four hours as needed for pain.

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