Where on the thigh do you do ACBs?
I remember reading an article around 2019 about ACBs in ACL surgery. They compared three injection locations based on the position of the femoral artery relative to the sartorius. The image below is what I remember about the three arms of the study:
If I remember correctly, the proximal group had the best outcomes (I think least morphine equivalents consumed with similar quad weakness.) Thus, I have been doing all my ACBs pretty high on the thigh, just distal to what would be...
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Source: Student Doctor Network - March 21, 2024 Category: Universities & Medical Training Authors: IDGARA Tags: Anesthesiology Source Type: forums
Narcotic administration in cardiac surgery cases
I am curious what everyone is doing currently for narcotic administration in cardiac surgery cases? Are people using infusions or just giving boluses before times of stimulation?
Unfortunately sufantanil has been available for a long period of time. When I was a medical student and starting residency some attendings were still giving 2mg/kg of morphine. That later evolved to giving 5000-6000 ug fentanyl and later 1000-1500 mg sufentanil. When ERAS and early extubation became popular...
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Source: Student Doctor Network - February 23, 2024 Category: Universities & Medical Training Authors: Drwine Tags: Anesthesiology Source Type: forums
Someone explain to me
I do a procedure, say an L5-S1 intralaminar epidural, and patient says they got 80% relief, but they are here for their legacy monthly refill of ms contin 15mg BID and morphine IR 15 QID for their 8/10 pain. Don't worry... It's under 90 OME so that means that it is okay. They are getting their alprazolam from their psychiatrist, I'm not the one writing it, so it's obviously okay. It makes no sense. There are only a few cases where the medication management doesn't essentially seem like I'm...
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Source: Student Doctor Network - February 5, 2024 Category: Universities & Medical Training Authors: OuttaLuckMove Tags: Pain Medicine Source Type: forums
Opioid Agonist Therapy Underused, Data Suggest
The low rates of opioid agonist therapy administration over time suggest that additional efforts are needed to promote this intervention in acute care settings, according to the researchers.
www.medscape.com
When you take policy statements from family docs seriously. Have others learned nothing from the past 30 year opioid disaster in the US?
Giving a long acting morphine to those with OUD is not in their or society's best interests. (Source: Student Doctor Network)
Source: Student Doctor Network - January 1, 2024 Category: Universities & Medical Training Authors: TheLoneWolf Tags: Pain Medicine Source Type: forums
Why is Morphine not popular?
It’s 1:1 equivalent with Hydrocodone. Doesn’t have the same euphoric effect of Oxycodone. Morphine IR for acute relief and ER for around the clock relief should be lot more common than it is.
Yet, I rarely see a Morphine script. Shouldn’t it be preferred over Oxycodone or Hydromorphone ? (Source: Student Doctor Network)
Source: Student Doctor Network - December 9, 2023 Category: Universities & Medical Training Authors: Chrish Tags: Pharmacy Source Type: forums
Why the hell does Medicare not cover bupe?
Got this lovely message today, in regards to an 86 year old woman, whose 2 tramadol per day are not helping anymore: Buprenorphine 5mcg/hr patch - Drug not on formulary - Plan does not cover the medication - We cannot do PA. She provided the preferred alternative: Morphine Sulfate ER tablets and Oxymorphone HCL ER tablets, and she submitted a test claim for both medications, stating that it was paid and that no PA was required.
In the midst of the "opioid epidemic" that everyone is...
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Source: Student Doctor Network - November 16, 2023 Category: Universities & Medical Training Authors: drrosenrosen Tags: Pain Medicine Source Type: forums
Tramadol
This report describes CDC’s updated clinical practice guideline for prescribing opioids for pain.
www.cdc.gov
So 2 tramadol a day is now a higher MME dose than oxycodone 5 BID? (Source: Student Doctor Network)
Source: Student Doctor Network - October 18, 2023 Category: Universities & Medical Training Authors: fathead88 Tags: Pain Medicine Source Type: forums
Consistently low creatinine on UDS??
I have a patient who was referred by a retiring rheumatologist on 90 MMES morphine. She was consistently short on her morphine and I transitioned to buprenorphine. Since starting buprenorphine every UDS (three times now) has reported abnormal creatinine (“dilute urine. May result in false negative. Possible deliberate diluation.”) Her UDS on her initial visit did not show abnormal creatinine.
Could there a physiological reason for this or is she being facitious? I felt I couldn’t definitely...
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Source: Student Doctor Network - September 20, 2023 Category: Universities & Medical Training Authors: PainBrain78 Tags: Pain Medicine Source Type: forums
Why morphine in peds?
I’ve noticed at my institution that people give hydromorphone for adults but morphine for peds. Is there a reason for this?
Morphine had active metabolites. Is it just because people are less likely to change their peds practice as fast as their adult practice? Is there an advantage to morphine? (Source: Student Doctor Network)
Source: Student Doctor Network - August 9, 2023 Category: Universities & Medical Training Authors: Dantrolene FC Tags: Anesthesiology Source Type: forums
Nurse diverting opioids for own use pleads guilty in federal court and may serve up to 10 years in prison
Suburban Chicago nurse pleads guilty to stealing morphine from patients
A suburban Chicago nurse has pleaded guilty to tampering with medications intended for patients under her care.
www.fox32chicago.com
Seems quite serious charges? And maybe a bit of a reach by the prosecutor?
"Diamond removed the morphine with reckless disregard and extreme indifference for the risk that the patients would be placed in danger of bodily injury," the U.S. attorney's office said in a statement.
Not sure if this quite reaches that level of reckless disr...
Source: Student Doctor Network - April 12, 2023 Category: Universities & Medical Training Authors: coffeebythelake Tags: Anesthesiology Source Type: forums
Belbucca TID?
Didn't get a ton of exposure to belbucca in fellowship, but want to use it more in my practice.
Have a patient who had previously been on methadone at roughly 120 MME who was rotated off of it to morphine and titrated down to about 60 MME by an NP at a different pain clinic locally. Patient didn't endorse great benefit from the morphine at any time she was on it, so I offered a rotation to belbucca. Currently on 150mcg BID dosing. She's getting good relief, but notes it isn't lasting got...
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Source: Student Doctor Network - December 4, 2022 Category: Universities & Medical Training Authors: agolden1 Tags: Pain Medicine Source Type: forums
Optimal fentanyl and morphine dose for CS spinal.
Can some OB experts update me on the “optimal doses”. Too many papers, all over the place. I will typically do 100-200 mcg morphine and 10-25 mcg fentanyl. (Source: Student Doctor Network)
Source: Student Doctor Network - October 19, 2022 Category: Universities & Medical Training Authors: dipriMAN Tags: Anesthesiology Source Type: forums
Obstetric case
26 y.o. G2P1 at Term for elective cesarean section.
PMH: nil.
Meds: nil.
Illicits: nil.
NKDA
165cm tall. Booking BMI 25.
Obstetric history:
Uncomplicated 2nd pregnancy.
First delivery was an emerg section at term for foetal distress (+/- chorioamnionitis)
Seen in clinic by a colleague. They noted the following re her first cesarean:
"Spinal anaesthetic performed at [backwater hospital] without issue [dose = 11.5mg heavy bupiv +15mcg fent + 150mcg morphine = total volume ~2.9mL].
Patient...
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Source: Student Doctor Network - June 11, 2022 Category: Universities & Medical Training Authors: woopedazz Tags: Anesthesiology Source Type: forums
Fentanyl sedation
Apparently the world just ran out of fentanyl. We can’t get any. Are you guys using IV morphine? (Source: Student Doctor Network)
Source: Student Doctor Network - February 22, 2022 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
intrathecal to IV or PO conversion of morphine?
Little help:
I do not management pumps. But we have a patient in the hospital that has a pump that is going to run out in about 4 days. Being asked to help manage potential withdrawal. I believe this patient has 1-2mg/day. What is the conversion for this? (Source: Student Doctor Network)
Source: Student Doctor Network - February 10, 2022 Category: Universities & Medical Training Authors: myrandom2003 Tags: Pain Medicine Source Type: forums
