Pain Management: Analgesia

Question 1

What to use for analgesia

Answer 1

OPIOIDS as boluses or infusions with breakthrough PRN opioids

Question 2

Other options for analgesia

Answer 2

APAP- avoid in liver failure
NSAID- avoid in AKI, increase risk of GI bleeds
Methadone- slow titration to avoid QTc prolongation
Gabapentin: may not see benefits for a couple of days
Ketamine
PCAs

Question 3

Scoring tools for pain

Answer 3

CPOT: significant pain is a score >2
BPS: significant pain is a score >5

Question 4

Opioids used for analgesia

Answer 4

Morphine, fentanyl, hydromorphone

Question 5

Morphine: onset

Answer 5

5-10 minutes

Question 6

Morphine: duration

Answer 6

3-6 hours

Question 7

Morphine: dose

Answer 7

Bolus: 2-10mg
Infusion: 1-10mg/hr

Question 8

Morphine: pearls

Answer 8

Active metabolite (morphine-6-glucuronide) → accumulates in renal impairment and extends the half-life of morphine

Histamine release → hypotension, bronchospasm, urticaria
Reason why patients have a morphine “allergy” in their profile

Question 9

Fentanyl: onset

Answer 9

seconds

Question 10

Fentanyl: duration

Answer 10

1-2 hours

Question 11

Fentanyl: dosing

Answer 11

Bolus: 50-100mcg
Infusion: 25-300mcg/hr

Question 12

Fentanyl: pearls

Answer 12

Hepatic metabolism (CYP3A4 interactions), tachyphylaxis

Resistance to the fentanyl → hydromorphone

Most used in the ICU

Question 13

Hydromorphone: onset

Answer 13

5 minutes

Question 14

Hydromorphone: duration

Answer 14

3-4 hours

Question 15

Hydromorphone: dosing

Answer 15

Bolus: 0.5-2mg
Infusion: 0.5-3 mg/hr