Chris Pasero, MS, RN-BC


April 23, 2013

Clinical Presentation: Motor Vehicle Accident

The patient is an otherwise healthy 51-year-old woman admitted to the intensive care unit (ICU) following a motor vehicle accident in which she sustained fractured ribs and a fractured femur. She underwent an open reduction and internal fixation to repair her fractured femur.

Pain History

The patient has had preexisting low back pain (10 years' duration) for which she was taking the following medications before admission:

  • Gabapentin 800 mg 3 times daily;

  • Controlled-release oxycodone 120 mg every 12 hours;

  • Oxycodone 5 mg/acetaminophen 325 mg as needed for breakthrough pain (average daily dose: oxycodone 40 mg and acetaminophen 2600 mg); and

  • Lidocaine patch 5%: 2-3 patches on her lower back as needed (patches worn for 12 hours, then removed for 12 hours and then replaced with new patches).

Postoperative Pain Management

On admission to the ICU, the patient's vital signs were within normal limits. She was NPO, so all oral medications were held. Her pain management included:

  • Intravenous (IV) fentanyl infusion titrated gradually upward to 150 mcg/hour according to pain ratings consistently > 7 on a scale of 0-10;

  • IV acetaminophen, 1000 mg every 6 hours; and

  • 3 lidocaine patches 5% were applied to the patient's lower back (removed after 12 hours, followed by a break for 12 hours, and then 3 new patches were applied).

Pain rating range was 7-10 on a scale of 0-10 at rest and during care activities.