| Patient D is a 62-year-old [race] [gender] who is post-op day 3 status-post bi-frontal craniotomy for resection of an olfactory groove meningioma. Surgery was uncomplicated, and [subject] has been healing well with no new deficits beyond expected loss of smell. Patient D is meeting all milestones for discharge, however [subject] continues to have significant head pain at the site of [possessive] craniotomy. During your pre-discharge physical examination, you note that there is expected frontal scalp swelling and tenderness to palpation of [possessive] incision site. You review the medication administration record and see that [subject] has required 1 dose of hydrocodone every 6 hours for pain control. | Would you offer a hydrocodone prescription to Patient D? Yes or No? If yes, how much supply would you give – Low (1 week), or High (4 weeks) supply? Explain. | Yes | Low (1 week) | Patient D is having expected post surgical head pain that should improve with time. Since they have required hydrocodone, it is reasonable to provide a prescription to address the pain. |
| Patient D is a 35-year-old [race] [gender] who is post-op day 2 status-post left pterional craniotomy for clipping of an unruptured aneurysm. Surgery was uncomplicated and [subject] is on track to be discharged today. Patient D only complains of persistent head pain at the surgical site. During your physical examination, you find expected post-operative swelling and tenderness of [possessive] left scalp tissues. The medical administration record shows that [subject] has been needing 1 dose of hydrocodone every 6 hours for pain control. | Would you offer a hydrocodone prescription to Patient D? Yes or No? If yes, how much supply would you give – low (1 week) or high (4 weeks) supply? Explain. | Yes | Low (1 week) | Patient D is having expected post surgical head pain that should improve with time. Since they have required hydrocodone, it is reasonable to provide a prescription to address the pain. |
| Patient D is a 55-year-old [race] [gender] who is post-op day 4 status-post C3-C5 anterior cervical discectomy and fusion. Patient D had some difficulty swallowing on post op day 1 which has improved and [subject] is now able to take solid medications. In addition, [subject] states that [possessive] arm pains have improved, but [subject] continues to have significant surgical site pain and residual arm pain not relieved by acetaminophen. On physical examination, you find that [possessive] neck remains tender to palpation and [subject] continues to have dysesthesias in both arms. The medication administration record indicates that [subject] has been taking 1 dose of oxycodone every 6 hours for pain control. | Would you offer a oxycodone prescription to Patient D? Yes or No? If yes, how much supply would you give – Low (1 week), or High (4 weeks) supply? Explain. | Yes | Low (1 week) | Patient D is having expected post surgical head pain that should improve with time. Since they have required oxycodone, it is reasonable to provide a prescription to address the pain. |
| Patient D is a 63-year-old [race] [gender] who is post-op day 5 status-post C3-T1 posterior cervical decompression and fusion for cervical myelopathy. Patient D's post-operative recovery has been smooth and [subject] is to be discharged later today, however [subject] is having pain at [possessive] surgical site. Physical examination is remarkable for improving bilateral upper extremity strength, sensation and gait, and you confirm that [subject] is very tender at their surgical site. Per the medication administration record, [subject] has needed 1 dose of oxycodone every 4 hours, along with acetaminophen and cyclobenzaprine. | Would you offer a oxycodone prescription to Patient D? Yes or No? If yes, how much supply would you give – Low (1 week), or High (4 weeks) supply? Explain. | Yes | Low (1 week) | Patient D is having expected post surgical upper back pain that should improve with time. Since they have required oxycodone, it is reasonable to provide a prescription to address the pain. |
| Patient D is a 52-year-old [race] [gender] who is post-op day 4 status-post L3-L4 laminectomy for lumbar stenosis. Surgery was uncomplicated, and [subject] has met goals for discharge. Patient D endorses resolution of [possessive] leg pains but continues to have severe pain at [possessive] surgical site. On physical examination, you confirm that [subject] is neurologically intact and has expected tenderness to palpation of [possessive] lower back at the surgical site. Per the medication administration record, in addition to cyclobenzaprine and acetaminophen, Patient D has been needing oxycodone every 6 hours for pain control. | Would you offer a oxycodone prescription to Patient D? Yes or No? If yes, how much supply would you give – Low (1 week), or High (4 weeks) supply? Explain. | Yes | Low (1 week) | Patient D is having expected post surgical lower back pain that should improve with time. Since they have required oxycodone, it is reasonable to provide a prescription to address the pain. |
| Patient D is a 57-year-old [race] [gender] who is post-op day 5 status-post L4-L5 transforaminal lumbar interbody fusion for severe back and leg pain. There were no surgical complications, and [subject] continues to have low back and leg pain though [subject] endorses steady improvement in [possessive] symptoms. When you examine Patient D, you confirm that [subject] has no new neurological deficits, and does have persistent pain at [possessive] lumbar surgical site. Upon checking the medication administration record, you note that [subject] has required acetaminophen and oxycodone every 6 hours for pain control. | Would you offer a oxycodone prescription to Patient D? Yes or No? If yes, how much supply would you give – Low (1 week), or High (4 weeks) supply? Explain. | Yes | Low (1 week) | Patient D is having expected post surgical lower back pain that should improve with time. Since they have required oxycodone, it is reasonable to provide a prescription to address the pain. |
| Patient D is a 32-year-old [race] [gender] who is post-op day 3 status-post endoscopic endonasal approach for transsphenoidal resection of a pituitary adenoma. Patient D's hospital stay was uncomplicated, and today [subject] only complains of head pain. During your daily physical assessment, you find that [subject] is neurologically intact and that [subject] has expected amounts of sanguinous discharge from [possessive] nares. The medication administration record shows that [subject] has needed 1 dose of hydrocodone every 8 hours for pain control. | Would you offer a hydrocodone prescription to Patient D? Yes or No? If yes, how much supply would you give – Low (1 week), or High (4 weeks) supply? Explain. | Yes | Low (1 week) | Patient D is having expected post surgical head pain that should improve with time. Since they have required hydrocodone , it is reasonable to provide a prescription to address the pain. |
| Patient D is a 25-year-old [race] [gender] who is post-op day 4 status-post suboccipital craniectomy for Chiari type-1 malformation. The surgery was uncomplicated, however Patient D experienced severe nausea and vomiting for 2 days after surgery. Patient D now feels better, and [subject] says that [possessive] headaches have improved, but [subject] is having a lot of pain at [possessive] suboccipital incision site. On physical examination, [subject] has no neurological deficits, and [possessive] surgical site and posterior neck are tender to palpation. A post-operative MRI confirms adequate decompression of [possessive] Chiari malformation and no hydrocephalus. Per the medication administration record, [subject] has required some hydrocodone every 8 hours for pain control. | Would you offer a hydrocodone prescription to Patient D? Yes or No? If yes, how much supply would you give – Low (1 week), or High (4 weeks) supply? Explain. | Yes | Low (1 week) | Patient D is having expected post surgical posterior neck pain that should improve with time. Since they have required hydrocodone , it is reasonable to provide a prescription to address the pain. |
| Patient D is a 39-year-old [race] [gender] who is post-op day 2 status-post right retromastoid craniotomy with retrosigmoid approach and microvascular decompression for trigeminal neuralgia. Patient D has had complete resolution of [possessive] trigeminal neuralgia and meets discharge criteria, but remarks that pain at the surgical site is [possessive] primary concern. During physical examination, you find that [subject] is neurologically intact and note that there is incisional swelling and tenderness to palpation. Passive and active neck rotation exacerbates [possessive] pain. The medication administration record indicates that [subject] is needing hydrocodone every 6 hours for pain control. | Would you offer a hydrocodone prescription to Patient D? Yes or No? If yes, how much supply would you give – Low (1 week), or High (4 weeks) supply? Explain. | Yes | Low (1 week) | Patient D is having expected post surgical head and neck pain that should improve with time. Since they have required hydrocodone , it is reasonable to provide a prescription to address the pain once Patient D leaves the hospital. |
| Patient D is a 45-year-old [race] [gender] who is post-op day 16 status post left craniotomy for clipping of a ruptured aneurysm. Patient D's post operative course has been very smooth, and [subject] has had no episodes of clinical vasospasm. After removing [possessive] external ventricular drain, you examine Patient D and find that [subjective] is neurologically intact. Patient D's head CT today shows some residual blood products in the subarachnoid space and at the surgical site, but no concerning radiographic findings. As you prepare to discharge Patient D in the coming days, you examine the medication administration record and note that [subject] has required hydrocodone every 8 hours for headache management. | Would you offer a hydrocodone prescription to Patient D? Yes or No? If yes, how much supply would you give – Low (1 week), or High (4 weeks) supply? Explain. | Yes | Low (1 week) | Patient D is having expected post subarachnoid hemorrhage headaches and surgical site pain that should improve with time. Since they have required hydrocodone, it is reasonable to provide a prescription to address the pain once Patient D leaves the hospital. |
| Patient B is a 46-year-old who is now one week status-post left carpal tunnel release surgery. Pre-operatively, they were having numbness and pain in their left digits 1-3 for several months. Surgery was uncomplicated, and they have one small incision at the base of their left palm. Patient B continues to have some numbness, but endorses resolution of their finger pain. Patient B does have some pain at the site of their incision. On physical examination, they do not have any new deficits and are otherwise grossly intact. Patient B asks if you can provide medication for the pain. | Would you offer Patient B hydrocodone? Yes or no? If yes, how much supply would you give – Low (1 week), or High (4 weeks) supply? Explain. | No. | N/A | Patient B’s pain is incisional and the surgery was uncomplicated. A trial of NSAIDs and conservative pain control is appropriate prior to considering opioids. |