Anaes SAQs · Perioperative medicine
Opioid-tolerant chronic pain perioperative care
Final-examination SAQ for opioid-tolerant-chronic-pain-perioperative.
On this page
Study tools
Target exams
ANZCAFRCAEDAICABAFCAI
Prompt
A patient takes oxycodone SR 40 mg BD and IR 10 mg q4h PRN for chronic pain, listed for laparotomy. Outline perioperative analgesic strategy including baseline opioids, multimodal/regional options, PCA, and discharge.
Model answer
Baseline (3). Start before theatre: assess the patient, calculate approximate oral morphine equivalents, and continue baseline equivalents perioperatively — do not stop cold.[1]
Multimodal/regional (4). Build a multimodal regimen around regional or fascial-plane options where the surgery allows; large-volume local techniques keep LAST on the radar.[1][3]
PCA (4). Set the PCA for tolerance — higher requirements than the opioid-naive — under monitoring with acute pain service involvement.[1]
Discharge (4). Plan the transition to outpatient care from the start: taper toward baseline with a written plan.[1]
References2ShowHide
- [1]Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain, 2016.PMID 26827847
- [3]Neal JM, Barrington MJ, Fettiplace MR, et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017. Reg Anesth Pain Med, 2018.PMID 29356773