Question

Mr. B is a 45-year-old man who has been in a drug treatment program for history of heroin use. He has been clean for 8 months. He has been taking methadone 10 mg twice daily. He has a history of degenerative disk disease, which causes low back pain and peripheral neuropathy in his bilateral lower extremities. In addition to the methadone, he also takes Percocet 5 mg/325 mg two tablets every 4 hours around the clock and gabapentin (Neurontin) 300 mg four times per day. He describes his baseline pain rating as 7 of 10.

Clinical Assessment

Mr. B is status post lumbar fusion and is admitted to the intensive care unit for pain management issues. Upon admission to the ICU, Mr. B is awake, alert, and oriented to person, place, time, and situation. He complains of incisional low back pain. His skin is moist and warm. Mr. B is able to move his lower extremities bilaterally but states that his feet have decreased sensation.

Diagnostic Procedures

Mr. B reports his pain as 10 on the Numeric Rating Scale (NRS). The Critical Care Pain Observation Tool (CPOT) score is 7.

Medical Diagnosis

Lumbar fusion secondary to degenerative disk disease.

1. What type(s) of pain is Mr. B experiencing during this postoperative period?

2. What medications could be used to manage Mr. B’s acute surgical pain while in the critical care setting?

3. What medications could be used to manage Mr. B’s neuropathic pain?

4. Considering Mr. B’s home pain management, what is he at risk for developing postoperatively?

5. Mr. B has been receiving opioids to manage his pain postoperatively. His respiratory rate is 6 breaths/min. What is Mr. B experiencing and how should it be managed? Explain.

6. What other alternatives are available to help Mr. B manage his pain? (Consider pharmacologic and nonpharmacologic methods.)

Answer 1