skip to main content

Chronic Opioid Perioperative Management — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePain MedicineChronic Opioid Perioperative ManagementFRCA Final

A 48-year-old woman with chronic back pain has used a transdermal fentanyl patch delivering 75 micrograms/hour at a stable dose for 2 years. She has no evidence of opioid toxicity and is scheduled for elective total abdominal hysterectomy. No preoperative opioid-reduction programme has been undertaken. What is the most appropriate perioperative opioid plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Continue the usual patch, avoid external heat over it, and supplement acute pain with titrated short-acting opioids

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

The established fentanyl patch provides baseline treatment for chronic pain and should usually be continued to prevent withdrawal and loss of background analgesia. It will not adequately treat the acute pain of an abdominal hysterectomy, so titrated immediate-release opioid analgesia, often including PCA, should be added within a multimodal plan. Opioid tolerance may increase supplementary requirements, necessitating specialist pain input and appropriate respiratory and sedation monitoring. External warming must not be applied over the patch because raised skin temperature can markedly increase fentanyl absorption. Options A and E interrupt baseline therapy and risk withdrawal; patch removal also does not immediately eliminate fentanyl because of continued absorption from the skin depot. Routine conversion to oral morphine is unnecessary and may be unreliable perioperatively. Doubling the patch is unsafe because transdermal dose changes are slow to titrate and may produce delayed toxicity.

Reference: Royal College of Anaesthetists, Faculty of Pain Medicine, Safe Anaesthesia Liaison Group and Centre for Perioperative Care. Modified release opioids and acute pain. 2025. https://www.rcoa.ac.uk/news/modified-release-opioids-acute-pain