A 10-Year-Old Boy With Acute Postoperative Pain: A Rational Approach to Opioid Prescribing

Johanne Lynch, MD; Fiona Campbell, MD; Jason Hayes, MD


August 17, 2010

Case Scenario Revisited

After the child has complained of pain in the postanesthesia care unit, bolus doses of morphine 1.5 mg intravenously every 5 minutes as required are prescribed. Repeated doses of morphine (a total of 3) are given to achieve a pain score of less than 3/10, and a morphine infusion at 20 μg/kg/hr is started. Later that day, the acute pain physician is asked to review the patient for worsening pruritus and nausea, despite repeated doses of diphenhydramine and ondansetron. After evaluation, the opioid is switched to a hydromorphone infusion at 4 μg/kg/hr, and scheduled doses of acetaminophen and ibuprofen are ordered. The adverse effects subside, and 36 hours later, the patient is switched to oral hydromorphone 2 mg every 6 hours as required. Nonpharmacologic techniques, such as cold packs and distraction, are used to facilitate the transition from intravenous to oral medication.


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