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INTRODUCTION

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HIGH ALERT

levorphanol (lee-vor-fan-ole)

Levo-Dromoran, Levorphan

Classification

Therapeutic: opioid analgesics

Pharmacologic: opioid agonists

Schedule II

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Indications
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Moderate-to-severe pain.

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Action
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Binds to opiate receptors in the CNS, altering perception of and response to pain. Produces generalized CNS depression. Therapeutic Effects: Decreased pain.

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Adverse Reactions/Side Effects
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CNS: confusion, sedation, dysphoria, euphoria, dizziness, floating feeling, hallucinations, headache, unusual dreams. EENT: blurred vision, diplopia, miosis. Resp: respiratory depression. CV: hypotension, bradycardia. GI: constipation, dry mouth, nausea, vomiting. GU: urinary retention. Derm: flushing, sweating, pruritus. Misc: physical dependence, psychological dependence, tolerance.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess symptoms of respiratory depression, including decreased respiratory rate, confusion, bluish color of the skin and mucous membranes (cyanosis), and difficult, labored breathing (dyspnea). Monitor pulse oximetry and perform pulmonary function tests (See Appendix I) to quantify suspected changes in ventilation and respiratory function. Excessive respiratory depression requires emergency care.

  • Be alert for excessive sedation or changes in mood and behavior (euphoria, dysphoria, confusion, hallucinations). Notify physician or nurse immediately if patient is unconscious or extremely difficult to arouse.

  • Use appropriate pain scales (visual analogue scales, others) to document whether this drug is successful in helping manage the patient's pain.

  • Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fainting, or other symptoms.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report slow heart rate (bradycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and help wean patient off opioid analgesics as soon as possible.

  • Because of the risk of respiratory depression, bradycardia, and hypotension, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, respiratory rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

  • Help patient explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, exercise, counseling, and so forth.

  • Guard against falls and trauma (hip fractures, head injury). Implement fall-prevention strategies (See Appendix E), especially if patient exhibits sedation, dizziness, or blurred vision.

  • To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

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Patient/Client-Related Instruction
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  • Advise patient that opioid analgesics are usually more effective if given before pain ...

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