Paeds Vivas · pain-palliative-and-end-of-life-care
Opioid stewardship and complex analgesia — branching viva
A branching viva following one postoperative child through the setup of a morphine patient-controlled analgesia device, the weight-based and PCA dosing with the sedation-score monitoring, the multimodal opioid-sparing backbone, the recognition and titrated naloxone reversal of opioid-induced respiratory depression, and the planned rotation to an oral opioid with the incomplete cross-tolerance reduction.
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Target exams
RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
Prompt
A nine-year-old is admitted after orthopaedic surgery with a morphine patient-controlled analgesia device. The examiner releases information in stages. The candidate must set the PCA parameters and the multimodal backbone, gate every dose on the pain score and the sedation score, recognise and reverse opioid-induced respiratory depression with titrated naloxone, and rotate to an oral opioid with the equianalgesic principle and the incomplete cross-tolerance reduction.
References6ShowHide
- [1]Donado C, Solodiuk J, Rangel SJ, et al. Patient- and Nurse-Controlled Analgesia: 22-Year Experience in a Pediatric Hospital Hospital Pediatrics, 2019.PMID 30655310
- [7]Quigley C Opioid switching to improve pain relief and drug tolerability Cochrane Database of Systematic Reviews, 2004.PMID 15266542
- [8]Bateman JT, Saunders SE, Levitt ES, et al. Understanding and countering opioid-induced respiratory depression British Journal of Pharmacology, 2023.PMID 34089181
- [9]Saari TI, Strang J, Dale O, et al. Clinical Pharmacokinetics and Pharmacodynamics of Naloxone Clinical Pharmacokinetics, 2024.PMID 38485851
- [10]Hadland SE, Agarwal R, Raman SR, et al. Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline Pediatrics, 2024.PMID 39344439
- [11]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 The Journal of Pain, 2016.PMID 26827847