A 41-year-old woman stabilised on methadone 80 mg daily for opioid dependence has had open reduction and inter…

Question

A 41-year-old woman stabilised on methadone 80 mg daily for opioid dependence has had open reduction and internal fixation of an ankle fracture. Four hours later she is distressed by severe pain despite regular paracetamol and parecoxib. The surgical registrar has withheld this morning's methadone dose and is reluctant to prescribe any opioid because of her 'addiction'. She is alert and not sedated, with a respiratory rate of 18/min. Which one of the following is the most appropriate plan for he…

Accepted Answer

Continue her methadone and add oral oxycodone

Answer

Add oral oxycodone and omit her methadone

Answer

Give buprenorphine in place of her methadone

Answer

Increase her methadone dose and give nothing else

Answer

Withhold all opioids and add regular tramadol

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