Practical guide to opioids and ketamine for pain management 

Sadly no evidence for reducing incidence, just severity… But epidurals do reduce incidence with a specific pre and post regime Have you seen any other ways of reducing indicence?

​@@ABCsofAnaesthesia no, we usually use regional anesthesia (epidural is considered too invasive for this around here). We might start low-dose antidepressants early, but that´s depending on the hospital treatment standards (and to be honest, I would need to look up the NNT).

Yes absolutely :) and Watchout all anti dopamines in parkinsons … Has anyone caused the perianal burning with an accidental rapid infusion of iv dexa?

@@ABCsofAnaesthesia hm.. I normally use it at the beginning of a case when the patient is already sleeping, so no feedback from them at that time ;) The times I used Dexa in awake patients (either as antiemetic or to extend the duration of a peripheral nerve block) it was no problem. This symptom is very rare and resolves within a minute on its own (according to literature), but nevertheless good to know, Thanks! Unfortunately the GOE is not good if you´re already nauseous and it takes half an hour to start to work, so its more of an "add on" to the other antiemetics to help you a bit later or as an "Hail Mary" kind of thing. And I try to avoid MCP at all (and encourage all my colleagues to do so) in favor of Deminhydrinate or 5HT3-antagonists, because of its potential for side-effects. The only times I use it is in ICU when treating GI-motility-disorders.

thanks so much for the comment Justin :)

Yeah true! We dont use hydromorphone in my hospitals What dosing regime do you use?

@@ABCsofAnaesthesia I use Hydromorphone (if it´s available in the hospital I work at, not all have it listed) when GFR (according to MDRD or CKD-EPI calculation) is