PACU care of pts with substance use/abuse

[wannabecnl]

I'm looking for good resources to learn how to provide better post-anesthesia care to my patients who use alcohol or other substances frequently. I have Drain's Perianesthesia Nursing (Critical Care Approach) text, which does include a chapter on substance using patients.

I've had an especially rough time with IV drug users--very difficult to medicate for surgical pain (their narcotic tolerance is so high), very difficult to establish any rapport or trust. It wore me out, but I want to do a good job with them when I have them.

Thanks.

[peaches88]

Good collaboration with your anesthesia provider is really important. Depending on the procedure and the patient, maybe have him/her look into doing a spinal or nerve block. If the procedure wouldn't allow for those options, sometimes our anesthesia providers will use ketamine to help control pain.

[peaches88]

Also, ASPAN just posted their winter/spring conference dates!

[brownbook]

As peaches said....your anesthesiologist should be your resource....these cases are so uniquely individualized most reference books would be too general.

I gave a opioid tolerant patient enough fentanyl to kill an elephant.....way over any recommended dose....per anesthesia orders.

I trusted the patients report of his pain and what he knew about his tolerance....and of course more importantly trusted the anesthesiologists orders.

The patient was awake and alert whole time.