EXERCISES: MEDICATIONS AND PAIN MANAGEMENT

EXERCISE 4.1

 

Purpose: To review management of side effects and complications from medications used to control pain and anxiety. How would you manage the following case scenarios of patients undergoing uterine aspiration?

 

  1. A patient states that last year they had an allergic reaction to the local anesthetic that her dentist used.
  2. A patient chooses to have IV pain management due to extreme anxiety. You administer midazolam 1 mg and fentanyl 100 mcg. As you dilate the cervix, the patient falls asleep and is not easily arousable. The oxygen saturation falls from 99% to 88%.
  3. A patient who is 5 weeks by LMP has a history of alcohol and heroin abuse, and states that they “shot up” yesterday. The patient wants all the pain medication possible for the aspiration procedure. Venous access is limited, but you finally succeed in inserting an IV and administer midazolam 1 mg and fentanyl 100 mcg. You insert the speculum, and the patient complains “I can feel everything” and “I need more meds”.
    1. How would you treat this pain? What do you need to take into consideration for patients with opioid tolerance?
    2. How would this change if they patient were on buprenorphine (Suboxone)?

Teaching Points

 

 

EXERCISE 4.2

 

Purpose: To become familiar with other medications used with uterine aspiration.

 

Please answer the following questions.

  1. In which of the following situations is administration of Rh-D immunoglobulin (Rhogam) suggested?
    1. Patient has positive anti-D antibody titre.
    2. Rh-negative patient received RhoGam 4 weeks ago during evaluation for threatened abortion.
    3. Rh-negative patient 4 days post-abortion who did not receive RhoGam at the uterine aspiration visit.
  2. While completing an early uterine aspiration procedure using local cervical anesthesia only, the patient complains of nausea and “feeling faint”. The patient is pale and sweating. The blood pressure is 90/50 and a pulse of 48.
    1. What is your differential diagnosis?
    2. How might you prevent this reaction?
    3. How would you manage this patient?

Teaching Points