Injection Morphine is given intrathecal during procedure for pain relief after the procedure. After procedure which of following analgesic you will not administer?

1. A

   Paracetamol

2. B

   Diclofenac

3. C

   Tramadol

4. D

   Fentanyl

Appeared in: AIIMS Delhi NO- 2019

Explanation

• Fentanyl is a potent synthetic opioid analgesic.
• Intrathecal morphine provides long-acting analgesia but carries a significant risk of delayed respiratory depression.
• Administering another potent opioid like fentanyl after intrathecal morphine creates an additive depressant effect on the respiratory system.
• This practice, known as 'opioid stacking,' significantly increases the risk of severe and potentially fatal respiratory depression and is therefore contraindicated.

Why Other Options Were Wrong

• Option A: Paracetamol (acetaminophen) is a non-opioid analgesic. It works through a different pathway and does not cause respiratory depression. It is a standard part of multimodal analgesia used alongside opioids to improve pain control and reduce opioid requirements.
• Option B: Diclofenac is a non-steroidal anti-inflammatory drug (NSAID). Its mechanism of action is peripheral, reducing inflammation and pain without causing respiratory depression. It is frequently used with opioids to enhance analgesia.
• Option C: Tramadol is an opioid, but it is significantly less potent than fentanyl or morphine. While combining any opioids requires caution, the risk of severe respiratory depression from adding tramadol is much lower than from adding fentanyl. Fentanyl is the most dangerous and therefore the most incorrect choice to administer.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Postoperative pain management and opioid safety as background academic context rather than a clinical decision trigger.
• A critical nursing responsibility is monitoring for respiratory depression for up to 24 hours after a patient receives intrathecal morphine. This includes frequent checks of respiratory rate, depth, sedation level (e.g., using the Pasero Opioid-Induced Sedation Scale), and oxygen saturation.
• The Society for Obstetric Anesthesia and Perinatology (SOAP) has specific guidelines for monitoring patients who have received neuraxial morphine, emphasizing the risk of delayed respiratory depression.
• Nurses must be vigilant in questioning any order for a potent systemic opioid in a patient who has received neuraxial morphine and should advocate for non-opioid or weaker analgesic alternatives first.

How to Approach the Question

• First, identify the key medication and its route: Intrathecal Morphine.
• Recall the drug class (potent opioid) and its most significant and dangerous side effect (delayed respiratory depression).
• Note the question's negative framing: 'which... you will NOT administer'. This means you are looking for the most dangerous option.
• Analyze the options based on their drug class and potential to interact with morphine.
• Option A (Paracetamol) is a non-opioid. Option B (Diclofenac) is an NSAID. Both are safe and recommended as part of multimodal analgesia.
• Option C (Tramadol) is a weak opioid. Option D (Fentanyl) is a very potent opioid.

Concept Tested & Keywords

• Concept Tested: Postoperative pain management and opioid safety
• Stem keywords: Intrathecal Morphine, post-procedure, pain relief, analgesic
• Lead-in keywords: not administer
• Clinical cues: Patient received intrathecal morphine, which signals a high risk for delayed respiratory depression.
• Negative lead-in flag: Question asks which analgesic to NOT administer.

Question ID

QxirA82kYShsxqV6QcYIuh

Copy ID

Reference Book

E6 Gynecology Williams p. 52-76

E6 Obstetrics Williams p. 63-84