Obsgynaecritcare

(Real Case: De-identified) You receive a call from a frantic ward nurse who tells you they have a 32 yr old woman who had laparoscopic surgery for treatment of endometriosis earlier in the day and she is in severe pain despite having had 3 doses of sublingual buprenorphine and 4 doses of tramadol since theatre 4 hours earlier. You head up to the ward and read her notes - she has had chronic pelvic pain since a teenager, she has been on analgesic drugs chronically for many years and been managed by her GP and a chronic pain service. She has a history of anxiety and depression and sexual abuse as an adolescent. Her current preoperative regimen involved tapentadol SR, amitriptyline, celebrex, pregabalin and prn oxycodone. In theatre she had a volatiel anaesthetic and a number of multi-modal analgesic medications including a small dose of methadone, ketamine, lignocaine. She needed a lot of fentanyl in recovery and since arrival on the ward has been very hard to control. You go and see her, she is definitely not