BCA Postoperative Pain Management 2 — Questions and Answers
Question 1: Which opioid analgesic is most appropriate for patients with renal failure in the postoperative setting?
- Morphine
- Meperidine
- Fentanyl (Correct answer)
- Codeine
Correct answer: Fentanyl
Fentanyl is preferred in renal failure because it lacks active metabolites that accumulate with impaired clearance.
Question 2: What is the primary mechanism by which gabapentin reduces postoperative pain?
- Inhibiting COX-2 enzymes
- Blocking voltage-gated calcium channels (Correct answer)
- Antagonizing NMDA receptors
- Enhancing opioid receptor sensitivity
Correct answer: Blocking voltage-gated calcium channels
Gabapentin binds to the alpha-2-delta subunit of voltage-gated calcium channels, reducing excitatory neurotransmitter release.
Question 3: A patient on chronic buprenorphine therapy undergoes elective surgery. Which perioperative analgesic strategy is most appropriate?
- Discontinue buprenorphine 72 hours preoperatively and use full opioid agonists
- Continue buprenorphine and supplement with higher-dose full opioid agonists as needed (Correct answer)
- Switch to methadone 24 hours before surgery
- Avoid all opioids and rely solely on regional techniques
Correct answer: Continue buprenorphine and supplement with higher-dose full opioid agonists as needed
Current evidence supports continuing buprenorphine perioperatively and using higher doses of full agonists to overcome partial agonist competition at mu receptors.
Question 4: Which route of ketorolac administration produces equivalent systemic analgesic efficacy to intravenous administration?
- Oral (Correct answer)
- Intramuscular
- Topical
- Rectal
Correct answer: Oral
Oral ketorolac achieves similar systemic plasma concentrations and analgesic effect as intramuscular or IV routes at equivalent doses.
Question 5: The concept of 'preemptive analgesia' is based on preventing which neurophysiological phenomenon?
- Opioid-induced hyperalgesia
- Central sensitization from nociceptive input (Correct answer)
- Peripheral opioid receptor downregulation
- Sympathetic nervous system activation
Correct answer: Central sensitization from nociceptive input
Preemptive analgesia aims to block afferent nociceptive signals before incision to prevent central sensitization and 'wind-up'.
Question 6: Which adjuvant is most effective for reducing opioid requirements after spine surgery specifically?
- Ondansetron
- Ketamine (Correct answer)
- Haloperidol
- Droperidol
Correct answer: Ketamine
Ketamine, an NMDA receptor antagonist, significantly reduces opioid consumption after spine surgery by blocking central sensitization.
Question 7: Postoperative ileus following abdominal surgery is best prevented by which analgesic approach?
- High-dose systemic opioids for complete pain control
- Thoracic epidural analgesia with local anesthetics (Correct answer)
- IV acetaminophen alone
- Intrathecal morphine in high doses
Correct answer: Thoracic epidural analgesia with local anesthetics
Thoracic epidural analgesia with local anesthetics reduces systemic opioid use and provides sympathetic blockade, both of which promote GI motility recovery.
BCA Postoperative Pain Management 2
Which opioid analgesic is most appropriate for patients with renal failure in the postoperative setting?