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TREATMENT OF ACUTE POSTOPERATIVE PAIN
Opioid analgesics and antagonists are extremely useful to ease acute pain postoperatively, when they should be used judiciously but not withheld for fear of adverse effects. They are often underused, resulting in needless pain and suffering. The required dosage is often underestimated and the duration of action overestimated. Physicians' and nurses' concerns about the development of psychologic dependence are excessive.
In the recovery room, morphine sulfate 2 mg IV or meperidine 12.5 mg is a reasonable starting dose for a nontolerant 70-kg patient. This may have to be repeated at short intervals (eg, q 15 to 30 min) until pain relief is established. Morphine sulfate 8 to 10 mg IM or s.c. q 3 h will usually provide pain relief on the ward. Higher doses provide greater analgesia and longer action. Elderly patients require a smaller dose than younger patients to obtain the same analgesia, and they are predisposed to side effects.
Given the great variability in individual responses, opioid dosage should be modified according to each patient's response. Frequent monitoring of pain relief, sedation, respiratory rate, and BP will guide the titration of the opioid dose. Initially, the drug may be given at the patient's request, and most opioids need to be repeated at least q 3 to 4 h. However, if the duration of analgesia is lesser 3 h, more frequent doses, or larger doses given less frequently, will be needed.
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