Acute Perioperative Pain Management, Multimodal Systemic Analgesia, and Enhanced Recovery Pathways — WACS Viva & Clinical Scenarios (General Anaesthesia)

Exam-style acute perioperative pain management, multimodal systemic analgesia, and enhanced recovery pathways viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: A 52-year-old male with severe chronic obstructive pulmonary disease (COPD, FEV1 48% predicted) is scheduled for major open pancreaticoduodenectomy (Whipple procedure). Due to severe lumbar spinal stenosis, thoracic epidural placement is contraindicated. Detail your comprehensive perioperative systemic multimodal analgesic regimen to provide optimal dynamic analgesia while preventing opioid-induced hypoventilation and pulmonary atelectasis.
• SCENARIO 2: A 38-year-old female with long-standing Crohn's disease on high-dose chronic oral oxycodone and tramadol presents for elective open ileocaecal resection. She expresses extreme anxiety regarding uncontrolled postoperative pain. Outline your strategy for preoperative opioid risk assessment, intraoperative opioid-sparing anaesthesia (including subanaesthetic ketamine and intravenous lidocaine infusions), and postoperative pain management.
• SCENARIO 3: You are tasked with chairing a multi-disciplinary committee to implement an Enhanced Recovery After Surgery (ERAS) pathway for major colorectal surgery in a tertiary West African teaching hospital. Outline the key preoperative, intraoperative, and postoperative anaesthetic elements of your evidence-based protocol, detailing how you overcome institutional resource bottlenecks.
• SCENARIO 4: A 45-year-old man in the surgical ward 6 hours following an open radical cystectomy on intravenous morphine PCA (1 mg bolus, 5-minute lockout) is found by the nursing staff to have a respiratory rate of 6 breaths/min, pin-point pupils, SpO₂ of 82% on room air, and is unarousable to verbal commands. Describe your immediate resuscitative and pharmacological management.