What type of pain management regimen would you suggest in the postoperative period? Explain your answer. Post-amputation pain (PAP) is challenging to manage, as there are multifactorial underlying mechanisms at play.

Such complexity requires a multidisciplinary care approach that involves medical, rehabilitative, and psychiatric services (Kent et al., 2017). Ideally these services would work congruently during the perioperative phase and a postoperative pain treatment plan would be developed during this time. Ghai et al. (2018) offer the following templet for the multidisciplinary care that is required during the peri and postoperative phases of a limb amputation in efforts of reducing PLP:  Identify patients for the prevention of PLP with detailed history taking, assessment of pain, special attention to neuropathic pain, pain questionnaire, anxiety and depression pain questionnaire, and neurological examination;  Consider a team approach including the surgeon, anesthesiologist, pain physician, physiotherapist, rehabilitation staff, and patient's caregivers; This study source was downloaded by 100000898494836 from CourseHero.com on 05-25-2025 20:39:09 GMT -05:00 https://www.coursehero.com/file/129251496/Opioid-Case-Group-Discussiondocx/ 2  Perioperative epidural analgesia with adjuvants (ketamine or calcitonin or opioids) (Level II) or IV opioid PCA (Level II) for optimized postoperative pain relief, starting 48 hours prior to surgery to minimum up to 72 hours postoperatively;  Include NSAIDs and paracetamol as part of multimodal analgesia;  Psychological support and rehabilitation;  Individualization approach regarding use of gabapentanoids as preventive strategy (p. 447). Additional pain prevention and management options include: i) alternative surgical techniques, ii) combining spinal epidural anesthesia with general anesthesia during surgery, iii) perineural catheters, iv) intravenous (IV) opioid patient-controlled anesthesia (PCA), and v) IV ketamine (Ghai et al., 2018). Despite numerous studies attempting to understand, prevent, and manage the multifactorial pains associated with limb amputations, no one method has been identified as superior (Ghai et al., 2018). Ghai et al. (2018) report that aggressive epidural anesthesia and opioid PCA have been deemed as acceptable measures to prevent PLP. Part 2 What dosing regimen would you suggest? According to Chisholm-Burns et al. (2019), 30 mg of hydrocodone is equivalent to 10 mg of parenteral morphine. The patient is taking 55 mg of morphine per day which would equate to 165 mg of hydrocodone per day without any adjustments for cross-tolerance and 82.5 mg of hydrocodone per day when adjusted by 50%. I would suggest hydrocodone/APAP 10/325 mg every four hours as needed for pain