Anesthesia Tutorial of the Week Quiz

1) Prescription opioids are a significant source of morbidity and mortality worldwide and contribute to the 'opioid epidemic.'

2) The combination of simple analgesia with opioid analgesia results in fewer opioids being required postoperatively

3) Opioids cause analgesia by modulating the ascending pain pathways only

4) The use of slow-release opioids to manage acute postoperative pain is encouraged by many anaesthetic institutions

5) The prescription of even a small amount of opioid analgesia increases the risk of a patient developing new persistent opioid use

6) Poorly controlled postoperative pain does not cause complications for patients

7) A patient complains of new severe abdominal pain four days after having a laparoscopic hemicolectomy. The best management of this patient is prescribing more opioid medication.

8) Patients with substance abuse disorders who undergo surgery should have their postoperative pain managed conjointly by pain and addiction medicine specialists

9) The risks of atypical opioids (such as tapentadol and tramadol) are similar to those of full mu opioid agonists.

10) A patient has a laparoscopic cholecystectomy. They are discharged 3 days after their procedure. In the 24 hours prior to their discharge they have used no opioid medication and are comfortable on simple analgesia alone. This patient should receive a prescription for opioids on discharge.

11) A 21-year-old male with no underlying medical conditions undergoes a laparoscopic appendicectomy. 2 days later they are discharged home. In the 24 hours prior to their discharge they have used 15mg of immediate release oxycodone as breakthrough analgesia (3 tablets of 5 mg). An example of a safe discharge prescription could be 1g paracetamol four times daily, 400mg ibuprofen 3 times a day for 5 days, and 10x 5mg oxycodone immediate-release tablets for use on an 'as needed basis every 4 hours.

12) A 50-year-old woman undergoes an uneventful minor orthopaedic procedure. As an inpatient, her pain is well controlled using simple analgesia and immediate release tapentadol for breakthrough pain. If she requires an opioid medication on discharge, she should be prescribed immediate-release oxycodone.

13) Pharmacists can be a helpful resource in the perioperative management of opioids

14) Patients should be counselled to expect no pain after their procedure

15) Non-pharmacological strategies should be utilised postoperatively, where possible, to reduce the amount of opioid medication required on discharge.

16) The Opioid Risk Tool can be used to determine a patient's risk of developing opioid-based side effects.

17) The most common source of prescription opioids used for recreational purposes is from people not known to the buyer (e.g. illicit drug dealers and the ‘black market’)

18) The amount of opioid medication prescribed on discharge may need to be reduced in patients with obstructive sleep apnoea.

19) Persistent postoperative opioid use only occurs after major surgery

20) Pain that develops after surgery and persists for more than 2 months is defined as chronic post surgical pain