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Chapter 70. Organization of an Acute Pain Management Service Incorporating Regional Anesthesia Techniques

Which statement is true regarding intravenous patient-controlled analgesia (IV-PCA)?

A. Without front loading, it takes at least three elimination half-lives before a minimum effective analgesic concentration (MEAC) is reached.

B. Addition of a basal infusion in IV PCA improves analgesia significantly.

C. When a patient is somnolent, nursing staff or family caregivers can make use of the IV PCA.

D. When converting opioids, one should always use the exact same dose.

A is correct. Before starting PCA, analgesia must be established with an initial loading dose of opioid. Without front loading, MEAC is not achieved for at least three elimination half-lives. PCA is intended to maintain a level of pain control, not to initiate satisfactory analgesia. Therefore, if the PCA process is interrupted by pump failure, a faulty intravenous line, or inadequate patient dosing, the patient will require bolus titration to achieve comfort before re-initiating PCA.

B is incorrect. Addition of a basal infusion in IV PCA does not add analgesic proportions; it does add side effects.

C is incorrect. Adverse events are correlated with inappropriate use of IV PCA, such as use by proxy.

D is incorrect. There is no uniform converting dose. A safety margin should be used when converting opioids because of incomplete cross-tolerance. Converting to 75% of the dose is advised.

Which statement is correct regarding peripheral nerve blocks and catheters?

A. All patients can be sent home in a day-care setting with a continuous peripheral nerve block catheter.

B. The peripheral infusion catheter can be removed only in a hospital environment.

C. Patients should be warned about local anesthetic systemic toxicity (LAST) and trained to recognize the symptoms (eg, dizziness, metal taste, tinnitus).

D. In case of catheter migration, the catheter can be left in place until the next planned visit.

C is correct. Patients should be warned about local anesthetic systemic toxicity (LAST) and trained to recognize the symptoms (eg, dizziness, metal taste, tinnitus).

A is incorrect. Not all patients can be sent home in day-care setting with a continuous peripheral nerve block catheter. Careful patient selection excludes high-risk patients (eg, hepatic or renal failure, coagulopathies).

B is incorrect. Depending on the circumstances, a peripheral infusion catheter can be removed at home by a trained nurse or by an educated caregiver.

D is incorrect. In case of ...

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