Opioid Case Discussion Part 1 Currently this 72-year-old woman is having pain rated as a 4 on a scale from 0 to 10. Her current medication list does not include any pain medications. “The American Geriatric Society (AGS) guidelines recommend acetaminophen as the initial (first-step) and ongoing pharmacotherapy for pain management; opioids are recommended for the treatment of moderateto-severe pain, and adjunctive analgesics are to be used for patients with specific pain types, such as neuropathic pain” (Caraceni et al., 2009). Prior to the surgery I would likely add Tylenol 1000mg PO Q6 PRN for pain. If the pain does not subside, I would consider adding oxycodone IR 5mg PO Q4 PRN and dropping the dose of the Tylenol to 650mg PO Q4 PRN. The rivaroxaban should be held for 24 hours prior to surgery to prevent excessive blood loss during surgery. If the surgery is considered to be high risk or if there is renal impairment, then it should be held at least 48-72 hrs. prior to the surgery. This 72-year-old woman is likely to experience acute post-surgical pain after the removal of the tumor on her right fallopian tube. Acute post-surgical pain can be classified as nociceptive, inflammatory, or neuropathic as well as either somatic or visceral (Cadaval Gallardo et al., 2022). In the case of this patient, I would classify her pain to be acute nociceptive visceral post-surgical pain. Post-surgical pain management would include Tylenol 1000mg PO Q6 PRN for pain 1-3; Oxycodone 5mg PO Q4 PRN for pain 4-7; Morphine 2mg Q2 IV PRN for pain 7- 10. This is on a case by case basis because at this time we do not know what type of surgery (open or laparoscopic) is being performed and we do not know he state of consciousness will be after surgery. In elderly patients it is best to start low and titrate up slowly if pain control is inadequate.
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