Managing acute postoperative pain: is 3 hours too long?
This case study discusses a 64-year-old opioid-tolerant patient who underwent amputation below the left knee and received pain management in the PACU. The patient's self-reported pain level remained 9 on a 0 to 10 scale despite having received a total of 62 mg of morphine sulfate (MSO 4 ) and 60 mg of ketorolac in just less than 3 hours. The patient's facial expression corresponded to a score of 4 to 5 based on the Wong-Baker Faces Pain Scale. This case study illustrates that it is crucial to promptly involve the pain management service when an opioid-tolerant patient requires aggressive pain treatment. The initial patient-controlled analgesia (PCA) order and MSO 4 -loading doses must take into account the patient history of opioid tolerance, increasing the frequency and dosage-loading doses of MSO 4 for treating severe pain until the patient's pain is reduced by at least 50% on a numeric scale, or until the patient states satisfactory relief. The most important rule of pain management is that pain is what the patient says it is.
Postanesthesia Care Unit, Miami VA Health Care System, FL 33125, USA. philipkang2000@yahoo.com
Philip
P
Ang
Hazel
H
Knight
Christina
C
Matadial
Ana
A
Pagan
Rosemarie
R
Curty
Carmen S
CS
Nieves
Ana A
AA
Acevedo
Francisca P
FP
Dalisay
D000208:Acute Disease; D000671:Amputation, Surgical / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D000701:Analgesics, Opioid / Q000378:metabolism / Q000627:therapeutic use; D016903:Drug Monitoring; D005149:Facial Expression; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000378:metabolism / Q000627:therapeutic use; D009730:Nursing Assessment; D009293:Opioid-Related Disorders / Q000150:complications*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000150:complications / Q000175:diagnosis / Q000378:metabolism / Q000517:prevention & control*; D010347:Patient Care Planning; D010353:Patient Education as Topic; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000601:surgery; D016528:Postanesthesia Nursing / Q000379:methods*; D017410:Practice Guidelines as Topic; D013997:Time Factors
D000701:Analgesics, Opioid; D009020:Morphine