March 2006, Volume 36 Number 3 , p 17 - 17
D'ARCY, YVONNE CRNP, CNS, MS
QUESTION: I'm caring for a 62-year-old woman recovering from a colon resection who has a history of chronic lower back pain. Preoperatively, she was taking 60 mg of extended-release morphine twice a day, 15 mg of short-acting morphine as needed for breakthrough pain (typically 3 doses per day), and 10 mg of cyclobenzaprine HCl at bedtime for muscle spasms. These medications haven't been restarted. Because she can't take oral medications postoperatively, she has a patient-controlled analgesia (PCA) pump.
After colon resection, most patients are comfortable on 1 mg of morphine every 8 minutes via bolus dose on a PCA pump, without a continuous infusion. But this isn't enough for my patient. What should I do?
ANSWER: When you plan postsurgical pain management for a patient who has chronic pain, remember to take into account the pain medications she's already taking. Convert the preadmission oral pain medication (120 mg P.O. plus ...