Opioid Resistant Pain Successfully Managed with Magnesium, Lidocaine and Ketorolac in the Post-Anesthesia Care Unit: A Case Series

Brandon Alan Van Noord,Jack Berger

doi:10.4172/2155-6148.1000196

Abstract

Opioid resistant pain in the Post-Anesthesia Care Unit is challenging and often poorly controlled. Post-operative pain greater than 7/10 pain despite 8 mg of IV morphine or equivalent was defined as opioid resistant pain. This case series reports five consecutive patients with opiate resistant pain who were successfully managed with a one-time concomitant IV bolus of 1 gm magnesium, 100 mg lidocaine, and 15 mg ketorolac. The patients were continuously monitored in the PACU. This novel combination produced greater than 50 percent mean pain score reduction with no adverse effects.

Highlights

We present a case series in which a combination of 1 gm magnesium (500 mg/ml, American Reagent), 100 mg lidocaine (20 mg/ml, Hospira), and 15 mg ketorolac (30 mg/ml, Hospira) successfully managed opioid resistant pain in the Post-Anesthesia Care Unit (PACU)
* 0.01 mg fentanyl, 0.167 mg hydromorphone, and 10 mg meperidine were used as 1 mg morphine equivalents (Pocket Anesthesia). ** Pt received 12.5 mcg intrathecal fentanyl logically exhibit synergistic instead of additive effects; analagous to the interaction between opioid and non-steroidal anti-inflammatory drugs [2]
Nerve injury creates a burst of glutamate-mediated activity at NMethyl-D-Aspartate (NMDA) receptors that is excitotoxic to inhibitory interneurons in the dorsal horn of the spinal cord, leads to pain disinhibition, and contributes to persistent pain [4]