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.
Ang
Philip
P
Postanesthesia Care Unit, Miami VA Health Care System, FL 33125, USA. philipkang2000@yahoo.com
Knight
Hazel
H
Matadial
Christina
C
Pagan
Ana
A
Curty
Rosemarie
R
Nieves
Carmen S
CS
Acevedo
Ana A
AA
Dalisay
Francisca P
FP
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