Therapeutic: opioid analgesics, analgesic adjuncts
Pharmacologic: opioid agonists
IV: Analgesic supplement to general anesthesia; usually with other agents (ultra–short-acting barbiturates, neuromuscular blockers, and inhalation anesthetics) to produce balanced anesthesia in patients who are intubated and ventilated. Induction/maintenance of anesthesia (with oxygen or oxygen/nitrous oxide and a neuromuscular blocker). Epidural: Obstetric pain during labor and vaginal delivery (in combination with bupivacaine). Unlabeled Use: Epidural: Postoperative pain.
Binds to opioid receptors in the CNS, altering the response to and perception of pain. Produces CNS depression. Therapeutic Effects: Supplement in anesthesia. ↓ pain.
Adverse Reactions/Side Effects
CNS: confusion, paradoxical excitation/delirium, postoperative depression, postoperative drowsiness. EENT: blurred/double vision. Resp: APNEA, CARDIAC ARREST, LARYNGOSPASM, allergic bronchospasm, respiratory depression. CV: arrhythmias, bradycardia, circulatory depression, hypotension. GI: biliary spasm, nausea/vomiting, constipation. Derm: facial itching. MS: skeletal and thoracic muscle rigidity. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess respiration, and notify physician immediately if patient exhibits any interruption in respiratory rate (apnea) or signs 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. Apnea or excessive respiratory depression requires emergency care.
Continually monitor for signs of cardiac arrest, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, nausea, and loss of consciousness. Seek immediate medical assistance if patient develops these signs.
Monitor signs of laryngeal spasm and allergic bronchospasm, including tightness in the throat and chest, wheezing, cough, and severe shortness of breath. Notify physician or nursing staff immediately if these reactions occur.
Be alert for other signs of allergic reactions and anaphylaxis, including skin reactions such as rash, pruritus, and urticaria. Notify physician or nursing staff immediately if these reactions occur.
Be alert for excessive sedation or changes in mood and behavior (confusion, depression, excitation, delirium). Notify physician or nursing staff 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) or signs of circulatory depression, including dizziness, fainting, weakness, pallor, and light-headedness.
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.
Be alert for residual muscle rigidity and decreased thoracic and limb movements. Report a sustained increase in muscle ...
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