Narcotics postoperative

Ms. dimes, an 80-year-old woman, is receiving a lower dose of Demerol, a narcotic analgesic, postoperatively for pain. Her family questions the use of a lower dose Determine what information you would give her family when they voice concerns that the dosage will not adequately relieve their mother s pain. Analyze what... 

Many postoperative patients require less narcotics when they are able to self-administer a narcotic for pain. Because the self-administration system is under the control of the nurse, who adds the drug to die infusion pump and sets the time interval (or lockout interval) between doses, the patient cannot receive an overdose of the drug. 

This type of pain management is used for postoperative pain, labor pain, and cancer pain. The most serious adverse reaction associated with the administration of narcotics by the epidural route is respiratory depression. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. Fentanyl is increasingly used as an alternative to morphine sulfate because patients experience fewer adverse reactions. 

The nurse immediately reports to the primary health care provider any significant change in the patient s vital signs. Narcotic analgesics can cause hypotension. Particularly vulnerable are postoperative patients and individuals whose ability to maintain blood pressure has been compromised. 

Postoperative narcotic depression (partial reversal) Smaller doses are usually sufficient. Titrate dose according to the patient s response. 

Postoperative narcotic depression - Follow the recommendations and cautions under adult administration guidelines. For initial reversal of respiratory depression, inject in increments of 0.005 to 0.01 mg IV at 2- to 3-minute intervals to desired degree of reversal. 

Adults - For preoperative use, 50 mg administered with an appropriately reduced dose of narcotic or barbiturate and the required amount of a belladonna alkaloid. For postoperative use, 25 to 50 mg doses in adults. 

Cough reflex Exercise caution when using narcotic analgesics postoperatively and in patients with pulmonary disease because cough reflex is suppressed. Intraoperative awareness Intraoperative awareness has been reported in patients younger than 55 years of age when remifentanil has been administered with propofol infusion rates of 75 mcg/kg/min or less. 

Analgesia, adjunctive therapy (parenteral only) - As pre- and postoperative and pre- and postpartum adjunctive medication to permit reduction in narcotic dosage. 

Children 1.1 mg/kg (0.5 mg/lb) IM to control emesis or as pre- and postoperative adjunctive medication to permit reduction of narcotic dosage. Reduce dosage of concomitant CNS depressants by 50%. 

Postoperatively, narcotics may be employed to control pain and discomfort for the first 1 to 3 d, but if prescribed indiscriminately, they may obscure the outcome of surgery and the course of recovery, as well as prevent the early recognition of complications. For headache, codeine may be... 

Opiate preparations, usually given as paregoric, are effective and fast acting antidiarrheal agents. These agents are also useful postoperatively to produce solid stool following an ileostomy or colostomy. A meperidine derivative, diphenoxylate, is usually dispensed with atropine and sold as Lomotil. The atropine is added to discourage the abuse of diphenoxylate by narcotic addicts who are tolerant to massive doses of narcotic but not to the CNS stimulant effects of atropine. 

Adjunct in pre/postoperative and pre/postpartum patients to aiiay anxiety, controi emesis, and reduce narcotic dose (injection)... 

Bromage PR, Camporesi E, Chestnut D. Epidural narcotics for postoperative analgesia. Anesth Analg 1980 59(7) 473-80. 

Opioid antagonists (Table 7.4), predominantly naloxone, are used clinically to reverse the effects of opiates in overdose or postoperative sedation. Naltrexone, which has oral bioavailability, is used for the treatment of narcotic addiction and alcohol dependence. As discussed below (Section 2.2.2.1), peripherally selective antagonists are being evaluated for treatment of constipation and other gastrointestinal side effects associated with opioid agonist use. 

Intramuscular hydroxyzine (100 mg q. 4 hours) is indicated for the acutely disturbed or hysterical patient the acute or chronic alcoholic with anxiety withdrawal symptoms or delirium tremens as pre- and postoperative and pre- and postpartum adjunctive medication to permit reduction in narcotic dosage, allay anxiety and control emesis and as an adjunctive therapy in asthma. 

It is a synthetic narcotic analgesic which possesses the action and uses of morphine and may be used for the relief of a variety of moderate to severe pain including the pain of labour and postoperative pain. Pethidine has atropine-like action on smooth muscle. It is normally used to induce both sedation and analgesia simultaneously. 

Naioxone (Narcan) Surmountably blocks opioid receptors. Has no effect in narcotic-free persons. Treatment of narcotic overdose. Diagnostic agent (for evaluation of addiction) in methadone programs. To reduce postoperative respiratory depression. Induces narcotic withdrawal syndrome (appetite loss, muscle contraction, fever/chills, restlessness, cardiovascular and respiratory symptoms, nausea,vomiting, diarrhea.)... 

Ketorolac (Toradol) The only nonsteroidal anti-inflammatory which is administered intramuscularly for pain relief. Initial clinical trials indicate that it is equal to narcotic analgesics for controlling postoperative pain. 

The client is postoperative for a cervical laminectomy and is prescribed meperidine (Demerol), a narcotic analgesic, by patient-controlled analgesia (PGA) pump. Which instruction regarding pain control should the nurse teach the client ... 

The client 4 hours postoperative bunionectomy (removal of hallux valgus) is prescribed hydromorphone (Dilaudid), a narcotic analgesic. The client is complaining of pain 9 on the 1-10 pain scale. Which action should the nurse implement ... 

Woodside JR. Female smokers have increased postoperative narcotic requirements. J Addict... 

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