aziatix-addicts

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Will you be checking in? by Andrew Carter

anonymous asked:

this is pretty specific and probably more on a case-by-case basis (sorry), but: if a character was taking ssris (so they can't take nsaids), had severe liver damage, and a history of heroin addiction, what kind of post-major surgery painkillers would they be given in the hospital? would it be more likely that they would be taken off their antidepressants to take a low dose of nsaids, or be given morphine risking a relapse, or some sort of numbing agent, or nothing, or something else?

Hey there nonny! First I’m going to take a bit of issue with your question, mainly with the statement “The character is taking SSRIs (so they can’t take NSAIDS).”

These two medication types, when combined, may increase the risk of your character developing  bleeding, but it’s more of a “use with caution” rather than “NEVER CROSS THE STREAMS”. Especially in a hospital setting, I don’t think the two of them would be problematic to administer together. I see patients on NSAIDs and SSRIs literally every day, though my caveat is that in a post-op setting they may refrain from using this combo, and I can’t seem to find any info definitively on that.

They’ll likely take a PT/PTT and an INR (basically, tests that see how long it takes your blood to clot) and look at the results and, if they’re not too far out of wack, just keep on trucking.

I wish I knew more about your definition of “major surgery”, because there are a lot of things that qualify as “major surgery” and they may have various levels of pain. This situation also changes drastically based on how much time the team has to prepare. If this character has two weeks to prep, yes, they might taper off the SSRI, load them up with NSAIDs, and go right on ahead with an opiate-free (or opiate-minimal) anesthesia plan.

If this person was hit by a bus and the OR is put together in a hurry, they’re getting opiates (likely fentanyl) and they can sort out the addiction issues later.

Now, the question of analgesia plus liver damage – I wish I knew if this was traumatic or hepatitic / cirrhotic –  in the setting of recent opiate addiction is a much more interesting one. Ultimately it’s going to come down to a lot of specifics: what are the LFTs showing? Is the liver still functioning, or is it in failure? Does the character WANT opiates, or are they willing to risk a lot of pain not to have any?

A “history of opioid addiction” could mean a lot of things, which is also where I’m having trouble with this ask. This could be that they are a current addict, that they entered recovery yesterday, or that they kicked the dope twenty years ago. Some in recovery refuse to even take aspirin for pain for fear of addiction, while others will take reasonable things (aspirin, all non-opiates) but not opiates. Some are willing to risk relapse by taking opiates, but only in the hospital.

Honestly, if it’s major surgery, they’re probably going to need analgesics. They can be given to the clock (rather than by request), and many doctors will pre-plan this with their patients.

It all comes down to who your character is and how they feel about opiates. But the first few days will be pretty painful even with good adjunctive therapies.

Best of luck with your story!

xoxo, Aunt Scripty

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