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Unrelieved pain in the immediate postoperative period following coronary artery bypass graft
!3393
DEMOGRAPHICS OF NARCOTIC INCREASERS IN A MEDICAL F’OPULATION. M.Kassirer, D.Sax* D.Osterberg* Dept. of Neurology, Boston University School of Medicine, VAOPC Boston,Mass. 02108 USA Aim of Investiqation: The demographics of the ongoing increasers of oral narcotics in a I6 month period in a general medical population is presented. Of 845 patients on oral narcotics in this period, only 28(3.3’$) were noted to be ongoing increasers or 0.134% of the general clinic population of 20,800. Method: A pharmacy survey at the VAOPC from IO/l/84 to l/31/86 revealed thatbut 28 of the 845 oatients who took oral narcotics either decreased, sustained, or discontinued their dose by l/31/86. Chart review of the 28 increasers revealed the group’s demographics. Results: The 28 increasers included I2 male Codelne users, average age 54.7 years, 45% married, 91% unemployed, 9% POW’s, and took an average 6f I4 Oxycodone users whose average age is 58 2.3 pills/d or 72 mg. Codeine. all male, 50% married, 88% unemployed, took an average of 2.4 pills years, One Meperidine increaser, male, age 68 years, /d or I I .5 mg. per day. divorced, unemployed, took 1.23 pills/d or 61.5 mg./d. One female Methadone user, age 56 years, took 5.67 pills/d or 28.35 mg./d. Of the Codeine users: 4 had headache, 6 rediculopathy, I low back strain, I acetabular fracture, I no organic basis, I no info. Oxycodone: 3 carcinoma, I multiple trauma, 2 headache, 2 diabetic neuropathy, 2 radiculopathy, I low back strain, I no Meperedine: I back pain with psychogenic component. Methadone: I Info. Only B/845(0.9$) patients were sequential users ankylosing spondylitis. whose average age is 48.6 years, all males, 25% married, 3 with post traumatic etiologies. It is apparent that in the general medical population there Conclusion: are very few ongoing increasers and even fewer sequential increasers for I2 months or more. The great majority of the patients have chronic persistent pain problems of medically identifiable etiology.
UNRELIEVED PAIN IN THE IMMEDIATE POSTOPERATIVE PERIOD FOLLOWING CORONARY ARTERY BYPASS GRAFT. Sheldon L. Burchmanlp2, Dudley .Johnson3*,Departments of 1Anesthesiologyand Emily Practice, Medical College of Wisconsin, and 3Department of Surgery, St. Mary's Hospital, Milwaukee, Wisconsin, USA.
I
Aim of investigation: This is a clinical observation on 23 patients who develooed extraordinarv aaitation and delirium in the -* oain nroblems. _ immediate postoperativeperiod following coronary artery bypass surgery. It is unusual for a pain management specialist to see this type of unusual and challenging problem that seems to be far removed from the mainstream of our work. Methods: The inability to control the patient's pain with PRN intravenous morphine in excess of the "usual" dosage of approximately 30 mgs. in a 24 hour period necessitated the institution of an intravenousmorphine drip. The use of psychotropic and anxiolytic drugs were needed to lessen the aaitation withdrawal symptoms. Results: The patients who truly had iatrogenic substance abuse to various opioids and other drugs were controlled with an intravenous drip of morphine in a range from 5-10 mgs. per hour. The other problems of agitation, delirium and pseudopsychoticepisodes responded well to the previous mentioned drugs. Conclusions: There is a problem in unrelieved postoperative cardiac pain and substance abuse. The failure to provide adequate analgesia may precipitate opioid withdrawal.
DEMOGRAPHICS OF NARCOTIC INCREASERS IN A MEDICAL F’OPULATION. M.Kassirer, D.Sax* D.Osterberg* Dept. of Neurology, Boston University School of Medicine, VAOPC Boston,Mass. 02108 USA Aim of Investiqation: The demographics of the ongoing increasers of oral narcotics in a I6 month period in a general medical population is presented. Of 845 patients on oral narcotics in this period, only 28(3.3’$) were noted to be ongoing increasers or 0.134% of the general clinic population of 20,800. Method: A pharmacy survey at the VAOPC from IO/l/84 to l/31/86 revealed thatbut 28 of the 845 oatients who took oral narcotics either decreased, sustained, or discontinued their dose by l/31/86. Chart review of the 28 increasers revealed the group’s demographics. Results: The 28 increasers included I2 male Codelne users, average age 54.7 years, 45% married, 91% unemployed, 9% POW’s, and took an average 6f I4 Oxycodone users whose average age is 58 2.3 pills/d or 72 mg. Codeine. all male, 50% married, 88% unemployed, took an average of 2.4 pills years, One Meperidine increaser, male, age 68 years, /d or I I .5 mg. per day. divorced, unemployed, took 1.23 pills/d or 61.5 mg./d. One female Methadone user, age 56 years, took 5.67 pills/d or 28.35 mg./d. Of the Codeine users: 4 had headache, 6 rediculopathy, I low back strain, I acetabular fracture, I no organic basis, I no info. Oxycodone: 3 carcinoma, I multiple trauma, 2 headache, 2 diabetic neuropathy, 2 radiculopathy, I low back strain, I no Meperedine: I back pain with psychogenic component. Methadone: I Info. Only B/845(0.9$) patients were sequential users ankylosing spondylitis. whose average age is 48.6 years, all males, 25% married, 3 with post traumatic etiologies. It is apparent that in the general medical population there Conclusion: are very few ongoing increasers and even fewer sequential increasers for I2 months or more. The great majority of the patients have chronic persistent pain problems of medically identifiable etiology.
UNRELIEVED PAIN IN THE IMMEDIATE POSTOPERATIVE PERIOD FOLLOWING CORONARY ARTERY BYPASS GRAFT. Sheldon L. Burchmanlp2, Dudley .Johnson3*,Departments of 1Anesthesiologyand Emily Practice, Medical College of Wisconsin, and 3Department of Surgery, St. Mary's Hospital, Milwaukee, Wisconsin, USA.
I
Aim of investigation: This is a clinical observation on 23 patients who develooed extraordinarv aaitation and delirium in the -* oain nroblems. _ immediate postoperativeperiod following coronary artery bypass surgery. It is unusual for a pain management specialist to see this type of unusual and challenging problem that seems to be far removed from the mainstream of our work. Methods: The inability to control the patient's pain with PRN intravenous morphine in excess of the "usual" dosage of approximately 30 mgs. in a 24 hour period necessitated the institution of an intravenousmorphine drip. The use of psychotropic and anxiolytic drugs were needed to lessen the aaitation withdrawal symptoms. Results: The patients who truly had iatrogenic substance abuse to various opioids and other drugs were controlled with an intravenous drip of morphine in a range from 5-10 mgs. per hour. The other problems of agitation, delirium and pseudopsychoticepisodes responded well to the previous mentioned drugs. Conclusions: There is a problem in unrelieved postoperative cardiac pain and substance abuse. The failure to provide adequate analgesia may precipitate opioid withdrawal.