Question

Following surgery he was placed on morphine patient-controlled analgesia (PCA). He has been using 55 mg of morphine/24 hours with adequate pain control; however, he developed redness and itching on his neck that is believed to be due to the morphine. Diagnosis of Phantom Limb Pain.

Current Meds: Morphine PCA; aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily; heparin 5000 units twice daily until discharged home. He will be discharged to a skilled nursing facility for rehabilitation therapy.

You would like to convert him to a combination preparation of hydrocodone and APAP for as-needed pain relief.

• What dosing regimen would you suggest?
• What would your monitoring plan include for this patient?
• How would you assess pain response?
• The patient is concerned about the redness and itching that he developed while on morphine. Would you document this as an allergic reaction?
• What other interventions or education may be necessary at this time?

Answer 1

1. The dosage regimen for oral hydrocodone and acetaminophen for phantom limb pain post discharge will be 5 mg hydrocodone- 325 mg acetaminophen every 4 to 6 hourly as needed for pain.    2. Monitor the patient closely for respiratory depression within first 24 to 72 hours of initiating therapy and following any increase in dose. Doses should be individually titrated to provide adequate analgesia while minimizing adverse reactions. 3. We can assess the pain response by using visual analog scale. Moreover assessing the wound would be able to rectify the intense of pain, whether healed or not.    4. Yes , I will document the incident of patient having redness and itching on neck while on morphine as an allergic reaction. Patient will be monitored for any extensive potential risk of this drug therapy.

5. EDUCATION-

1. Advise the patient to store this drug safely out of the sight and reach of children. It should be protected from light and moisture. 2. Should educate about the potential life threatening respiratory depression and to be informed as to when this risk is greatest; patient and caregiver should get emergency help right away. 3. Patient should not take this drug along with alcohol. 4. This drug may cause drowsiness, dizziness or impaired thinking or motor skills; patient should avoid driving. 5. Monitor for the development of behaviors indicative of addiction, abuse or misuse.