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Perioperative Pain Management for the Chronic Pain Patient With Long-Term Opioid Use

doi: 10.1097/NOR.0000000000000548
Departments: CE Tests
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Registration Deadline: March 5, 2021

Provider Accreditation:

Lippincott Professional Development (LPD) will award 1.5 contact hours for this continuing nursing education activity. This activity has been assigned 1.0 pharmacology credits.

LPD is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.5 contact hours. LWW is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida #50-1223.

Disclosure: The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

This article has been approved by the Orthopaedic Nurses Certification Board for Category A credit toward recertification as an ONC.

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CE TEST QUESTIONS

GENERAL PURPOSE: To provide information on strategies for treating acute postoperative pain in opioid tolerant patients.

LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:

  1. Identify postoperative issues related to the preoperative use of opioids.
  2. Select strategies for postoperative pain management in patients who used opioids preoperatively.
  1. According to the Centers for Disease Control and Prevention (2017), patients with which of the following characteristics are most likely to be prescribed opioids?
    1. men
    2. non-Hispanic whites
    3. adults aged 30–35 years
  2. In the 2018 study by Hilliard, what percentage of patients undergoing surgery reported preoperative opioid use?
    1. 11.4%
    2. 23.1%
    3. 39.7%
  3. In the Hilliard (2018) study, opioid use was most common in patients undergoing
    1. total knee arthroplasty.
    2. total hip replacement.
    3. orthopedic spinal surgery.
  4. In the case described in this article, what medication did the patient receive in the preoperative holding area to help with pain control?
    1. pregabalin
    2. baclofen
    3. tramadol
  5. To transition this patient back to oral medications, based on his total intravenous (IV) patient-controlled analgesia (PCA) use in the preceding 24 hours he was started on oral oxycodone at
    1. the dose that he was on at home.
    2. two times the dose that he was on at home.
    3. three times the dose that he was on at home.
  6. Research by Chapman (2011) on chronic pain patients undergoing surgery revealed that the patients who were on opioids preoperatively had
    1. a much higher level of initial pain after surgery.
    2. some minor signs and symptoms of withdrawal from opioids postoperatively.
    3. a much slower resolution of postoperative pain than the chronic pain patients who were not on opioids preoperatively.
  7. Rajpal (2010) reported that the heightened physiologic stress response that results from poorly controlled pain results in
    1. gastrointestinal bleeding.
    2. delayed healing.
    3. a longer length of hospital stay.
  8. In the 2015 study by Lerman, what predicted both the level of pain and pain-related disability?
    1. the duration of the patient's chronic pain
    2. the patient's support system
    3. the patient's depression and anxiety symptoms
  9. Research by Zywiel (2011) revealed that, compared to patients who did not use opioids preoperatively, patients with preoperative chronic opioid use who had total knee arthroplasty (TKA) had a significantly higher rate of complications, including
    1. wound infections or cellulitis.
    2. pneumonia or other respiratory infection.
    3. revision or repeat arthroscopic evaluation.
  10. In the 2018 review by Weick, all of the following were true about opioid naïve patients who had undergone TKA or total hip arthroplasty 1 year earlier except that they
    1. were less likely to need an early surgical revision.
    2. had higher rates of opioid dependence postoperatively.
    3. had lower 30-day readmission rates.
  11. Cozowicz (2017) reported that higher opioid prescription levels postoperatively correlated with
    1. a shorter length of stay.
    2. a greater risk of requiring intensive care.
    3. higher rates of infection.
  12. The authors note that there should be pre- and postoperative discussions with patients about
    1. not needing opioids once they are discharged.
    2. realistic expectations about post-operative pain control.
    3. signs of overdose during hosptialization.
  13. As noted in the article, what holds the same level of priority as achieving optimal pain management?
    1. maintaining a good appetite and appropriate nutrition
    2. participating in physician-ordered physical therapy
    3. avoiding over-sedation or respiratory depression
  14. According to the Guidelines on the Management of Postoperative Pain by The American Pain Society and American Society of Anesthesiologists (2016) regarding opioid dosing,
    1. long-acting opioids should be maintained at the same dose and scheduling to avoid withdrawal.
    2. short-acting or immediate release opioid doses should be decreased.
    3. transdermal opioids and implanted intrathecal pump infusions should be temporarily replaced with PCA.
  15. As noted in the article, what may be just as important as pulse oximetry in preventing adverse outcomes from opioids?
    1. mental status changes and respiratory rate
    2. end-tidal capnography
    3. monitoring the total dose of opioids
  16. In the 2010 review by Rajpal, the addition of what oral medication preoperatively resulted in a reduction of postoperative pain, opioid consumption, and related adverse effects?
    1. acetaminophen
    2. gabapentin
    3. amitriptyline
  17. In the 2010 study by Rajpal, the patients who required significantly less opioid to control their pain, had fewer side effects and functional issues, and greater patient satisfaction had received
    1. IV PCA with opioids.
    2. oral multimodal therapy.
    3. regional nerve blocks.
  18. The authors note that the use of what therapy has been validated for pain control in the postoperative period?
    1. transcutaneous electrical nerve stimulation (TENS)
    2. acupuncture
    3. massage
  19. What does Chou (2016) report has been shown to have positive effects on pain, anxiety, and analgesic use?
    1. cognitive-behavioral therapies
    2. Reiki therapy
    3. attention diversion
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