Preoperative assessment: chronic opioid therapy: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Preoperative assessment: chronic opioid therapy

Sample item

A 50-year-old man takes oral morphine daily for chronic cancer pain and is listed for surgery. What is the best perioperative analgesic plan?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Continue his usual opioid dose and add multimodal analgesia, expecting higher requirements

Patients on chronic opioids are tolerant and risk withdrawal if therapy stops, so their baseline dose is continued in addition to analgesia for the surgical pain. Regional techniques, paracetamol and non-opioid adjuncts reduce the extra opioid needed.

Option by option

  • A. Stop the morphine 24 hours before surgery to avoid respiratory depression

    Stopping the drug risks withdrawal and uncontrolled pain.

  • B. Convert entirely to tramadol, since it has no opioid effect

    Tramadol is a weak opioid agonist, so it cannot be considered opioid-free.

  • C. Give standard opioid doses, since tolerance does not develop to analgesia

    Tolerance does develop, so standard doses are often inadequate.

  • D. Continue his usual opioid dose and add multimodal analgesia, expecting higher requirements (correct)

    Correct. Baseline opioid is maintained and extra analgesia is layered on top.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Continue his usual opioid dose and add multimodal analgesia, expecting higher requirements. Patients on chronic opioids are tolerant and risk withdrawal if therapy stops, so their baseline dose is continued in addition to analgesia for the surgical pain.

Why is "Stop the morphine 24 hours before surgery to avoid respiratory depres…" not the answer?

Stopping the drug risks withdrawal and uncontrolled pain.

Why is "Convert entirely to tramadol, since it has no opioid effect" not the answer?

Tramadol is a weak opioid agonist, so it cannot be considered opioid-free.

Why is "Give standard opioid doses, since tolerance does not develop to analg…" not the answer?

Tolerance does develop, so standard doses are often inadequate.

What concept does this question test?

It tests Preoperative assessment: chronic opioid therapy in Anaesthesia. Regional techniques, paracetamol and non-opioid adjuncts reduce the extra opioid needed.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Preoperative assessment: chronic opioid therapy?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.