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Perioperative Chronic Opioid — RACP Adult Medicine MCQ

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HardClinical PharmacologyPerioperative Chronic OpioidRACP Adult Medicine

A patient taking a stable 200 mg oral-morphine-equivalent daily opioid regimen is admitted for major abdominal surgery. There is no intoxication, acute kidney injury or contraindication to regional techniques. Which perioperative principle is most appropriate?

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

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Correct answer: D — Continue the verified baseline opioid, add multimodal analgesia and titrate monitored rescue opioid to postoperative effect

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

E is correct. The usual opioid requirement prevents withdrawal and covers only the patient’s baseline state; surgical pain requires additional multimodal analgesia, often including regional techniques and higher-than-opioid-naive rescue requirements with close respiratory monitoring. A creates avoidable withdrawal and makes postoperative titration harder. B falsely assumes tolerance disappears under anaesthesia. C mistakes a valuable component for a guaranteed complete strategy and leaves no rescue plan if the block is incomplete or resolves. D is unsafe because high-dose opioid rotation, especially to methadone, requires specialist nonlinear conversion and monitoring. Preoperative planning should document the actual daily dose, prescriber, route, discharge plan and expectations.

Reference: ANZCA PS41(G): Acute pain management: https://www.anzca.edu.au/getattachment/558316c5-ea93-457c-b51f-d57556b0ffa7/PS41-Guideline-on-acute-pain-management