RT Book, Section
A1 Jobst, Erin E.
A1 Panus, Peter C.
A1 Kruidering-Hall, Marieke
SR Print(0)
ID 1192816551
T1 Opioid Analgesics and Antagonists
T2 Pharmacology for the Physical Therapist, 2e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781259862229
LK accessphysiotherapy.mhmedical.com/content.aspx?aid=1192816551
RD 2024/04/19
AB CASE  STUDYS.F.  is  a  58-year-old  woman  with  a  long  history  of  bilateral  knee  osteoarthritis.  For  the  past  several  years,  conservative  treatment  has  included  physical  therapy  and  medications  (oral  cyclooxygenase-2  [COX-2]  inhibitors  and  intra-articular  triamcinolone  acetonide  injections).  Because  she  has  had  progressively  more  pain  and  dysfunction  over  the  past  year,  S.F.  and  her  primary  physician  determined  that  it  was  time  for  bilateral  total  knee  arthroplasties  (TKA).  The  patient  subsequently  underwent  bilateral  TKA  without  complication.  Postsurgical  inpatient  pain  management  includes  oral  oxycodone  and  a  PCA  pump  with  morphine  sulfate  for  breakthrough  pain.  Early  physical  therapy  interventions  on  postoperative  days  1  and  2  focused  on  active  and  passive  range  of  motion  (ROM)  of  both  lower  extremities,  transfer  training,  and  upright  mobility  training.  Prior  to  surgery,  S.F.  stated  that  her  goal  was  to  discharge  from  the  hospital  directly  to  her  home.  Her  strong  preference  is  not  to  be  admitted  to  a  skilled  nursing  facility,  even  for  a  short  time.  In  line  with  this  goal,  S.F.  has  eagerly  and  actively  participated  in  twice-daily  physical  therapy  sessions.  She  has  informed  the  nursing  staff  that  she  has  a  low  tolerance  for  pain  and  asks  for  the  oral  pain  medication  30-45  minutes  before  each  therapy  session.  Initially,  S.F.  tolerated  ROM  exercises  and  limited  mobility  training  well  with  this  “pain  premedication”  regimen.  However,  upon  standing  and  attempting  gait  training  on  postoperative  day  three,  S.F.  experienced  dizziness,  diaphoresis,  and  became  very  short  of  breath.  On  the  second  attempt  to  stand,  the  patient  experienced  syncope.