Enhanced Recovery After Surgery (ERAS) protocols include multimodal analgesia. Which combination of analgesic techniques best reflects an ERAS multimodal approach for major colorectal surgery?
- A PCA morphine alone with rescue IV opioids
- B Intramuscular pethidine every 4–6 hours as scheduled
- C Preoperative oral paracetamol + celecoxib, intraoperative thoracic epidural or TAP block, postoperative paracetamol + NSAID + opioid as rescue only ✓
- D Fentanyl infusion at 25 mcg/hour continued for 48 hours postoperatively
Explanation
ERAS multimodal analgesia aims to minimise opioid use (reducing ileus, nausea, respiratory depression, early mobilisation barriers) through combining agents targeting different pain mechanisms: preemptive analgesia (paracetamol/COX-2 inhibitor before incision), regional anaesthesia (thoracic epidural gold standard for open surgery; TAP block for laparoscopic), and scheduled non-opioid analgesia postoperatively. Opioids are reserved as rescue analgesia only. This achieves superior analgesia with fewer opioid-related side effects and faster recovery. Scheduled IM pethidine is no longer recommended (risk of norpethidine accumulation causing seizures).
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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