A 43-year-old woman is seen in the hospital following a laparoscopic cholecystectomy. The patient had no significant operative complications but was observed overnight due to nausea during recovery from anesthesia. The nausea has resolved and she is tolerating a regular diet. The patient reports continuous moderate incisional pain with occasional spikes of increased pain with movement. Medical history is unremarkable and she takes no chronic medications. She does not use tobacco, alcohol, or illicit drugs.
Vital signs are normal. Examination shows intact abdominal incisions with normal bowel sounds and no significant abdominal tenderness. The remainder of the examination is normal.
Which of the following is the most appropriate prescription for home pain control for this patient?

Question

A 43-year-old woman is seen in the hospital following a laparoscopic cholecystectomy.  The patient had no significant operative complications but was observed overnight due to nausea during recovery from anesthesia.  The nausea has resolved and she is tolerating a regular diet.  The patient reports continuous moderate incisional pain with occasional spikes of increased pain with movement.  Medical history is unremarkable and she takes no chronic medications.  She does not use tobacco, alcohol, or illicit drugs.
Vital signs are normal.  Examination shows intact abdominal incisions with normal bowel sounds and no significant abdominal tenderness.  The remainder of the examination is normal.
Which of the following is the most appropriate prescription for home pain control for this patient?

Quizplus · Accepted Answer

Overprescribing of opioid analgesics is associated with risk for abuse and diversion. Even when the initial indication for opioid therapy is appropriate, excess pills can be misused by patients and others, leading to overdose and dependence. Strategies to reduce overprescribing include: Using non-opioid medications (eg, acetaminophen, nonsteroidal anti-inflammatory drugs) for mild pain (eg, low back pain, headache)For patients with moderate to severe pain who require opioid therapy, prescribing limited quantities and providing frequent follow-up to reassess opioid requirements Using non-opioid medications (eg, acetaminophen, nonsteroidal anti-inflammatory drugs) for mild pain (eg, low back pain, headache) Using non-opioid medications (eg, acetaminophen, nonsteroidal anti-inflammatory drugs) for mild pain (eg, low back pain, headache) For patients with moderate to severe pain who require opioid therapy, prescribing limited quantities and providing frequent follow-up to reassess opioid requirements For patients with moderate to severe pain who require opioid therapy, prescribing limited quantities and providing frequent follow-up to reassess opioid requirements This opioid-naive patient has moderate postoperative incisional pain. Short-acting opioids (eg, hydrocodone, oxycodone) are appropriate and can be combined with acetaminophen or a nonsteroidal anti-inflammatory drug (eg, ibuprofen) to reduce opioid requirements (short-acting hydrocodone is available in the United States only in combination with acetaminophen or ibuprofen). However, most patients with uncomplicated laparoscopic cholecystectomy have a significant reduction in pain within the first 3 days. Therefore, the most appropriate care for this patient is to provide a short-term (3-5 days) opioid prescription with availability for office follow-up if pain persists beyond that time. (Choices B and C) The analgesic effect of codeine is more variable than that of other opioids. Oxycodone or hydrocodone are more appropriate for postoperative patients, but a 7-day supply is more than is needed for most patients. (Choice D) Tramadol can provide relief of mild to moderate pain, including postoperative pain, and may be associated with a reduced risk of abuse compared to other opioids. However, the risk of misuse of tramadol is still substantial, and a 14-day supply is excessive. (Choice E) A fentanyl transdermal patch can provide relief of chronic pain for up to 72 hours. However, long-acting opioids are associated with increased risk of respiratory depression and are not recommended for acute pain in opioid-naive patients. Educational objective: Strategies to reduce overprescribing of opioid medications include using non-opioid medications for mild pain and prescribing limited quantities of opioid medications for moderate to severe pain. For most patients with moderate postoperative pain, a short-term (3-5 days) prescription of an opioid analgesic is appropriate. __________ References: Costs and consequences: a review of discharge opioid prescribing for ongoing management of acute pain. (http://www.ncbi.nlm.nih.gov/pubmed/25233168)

A 43-Year-Old Woman Is Seen in the Hospital Following a Laparoscopic