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Postoperative Pain Management Flashcards

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  1. What is the ceiling effect of buprenorphine most clinically relevant to in postoperative analgesia?

    Answer: Respiratory depression plateaus at higher doses than analgesia

    Buprenorphine's partial agonism means respiratory depression reaches a ceiling at subanesthetic doses, making it safer than full agonists in overdose.

  2. Which parameter best guides dose titration of patient-controlled analgesia (PCA) when a patient reports inadequate pain relief between PCA doses?

    Answer: Increase the demand dose

    Increasing the demand dose delivers more opioid per activation when baseline pain is undertreated between doses.

  3. A postoperative patient develops pruritus after intrathecal morphine. What is the first-line treatment?

    Answer: Nalbuphine 5 mg IV

    Nalbuphine, a mixed agonist-antagonist, reverses neuraxial opioid-induced pruritus without fully reversing analgesia.

  4. Celecoxib differs from ketorolac in the postoperative setting primarily because celecoxib:

    Answer: Does not impair platelet aggregation

    Celecoxib selectively inhibits COX-2 and does not inhibit COX-1-mediated thromboxane A2 production, preserving platelet function.

  5. Which nerve block is the most appropriate single regional technique for total knee arthroplasty analgesia that avoids motor blockade of the quadriceps?

    Answer: Adductor canal block

    The adductor canal block targets the saphenous nerve (sensory) within the canal, sparing the motor branches to the quadriceps that exit proximally.

  6. Opioid-induced hyperalgesia (OIH) is best distinguished from opioid tolerance by which clinical finding?

    Answer: Pain that spreads beyond the original surgical site

    OIH characteristically produces diffuse, poorly localized pain extending beyond the original painful area, unlike tolerance which causes diminished effect at the same dose.

  7. When performing a transversus abdominis plane (TAP) block for lower abdominal surgery, which nerve roots are targeted?

    Answer: T10–L1

    The TAP block targets the T10–L1 anterior cutaneous branches as they travel through the neurofascial plane between the internal oblique and transversus abdominis muscles.