06-25-2007, 04:58 AM
A 61-year-old man underwent a total colectomy for ulcerative colitis 4 hours ago. He has a 15-year
history of the disease and after a recent protracted flare that failed medical management, he was taken
to the operating room for a colectomy. He received a lumbar epidural that was used for analgesia
during his case and in the recovery room with good effect. You are called to see him on the floor for
pain. The patient reports 9/10 pain on a visual-analog scale (VAS) and examination reveals that he has
no appreciable sensory level from his epidural. The infusion drug is a mixture of 0.1% bupivacaine and
hydromorphone and it is infusing at a maximal rate of 15cc/hour. The most appropriate management at
this time is to
A. bolus the catheter with the infusion mixture
B. call the pain service
C. discontinue the hydromorphone in the epidural mix and initiate patient controlled
analgesia with morphine
D. initiate intravenous morphine every 3 hours as needed
E. maintain the hydromorphone in the epidural mixture and initiate patient controlled analgesia
with morphine
history of the disease and after a recent protracted flare that failed medical management, he was taken
to the operating room for a colectomy. He received a lumbar epidural that was used for analgesia
during his case and in the recovery room with good effect. You are called to see him on the floor for
pain. The patient reports 9/10 pain on a visual-analog scale (VAS) and examination reveals that he has
no appreciable sensory level from his epidural. The infusion drug is a mixture of 0.1% bupivacaine and
hydromorphone and it is infusing at a maximal rate of 15cc/hour. The most appropriate management at
this time is to
A. bolus the catheter with the infusion mixture
B. call the pain service
C. discontinue the hydromorphone in the epidural mix and initiate patient controlled
analgesia with morphine
D. initiate intravenous morphine every 3 hours as needed
E. maintain the hydromorphone in the epidural mixture and initiate patient controlled analgesia
with morphine