The presence of sedation does not necessarily mean that patients are comfortable, and despite being excessively sedated, some patients will report pain (Pasero, Quinn, Portenoy, McCaffery, & Rizos, 2011). Further, sleep during opioid titration is not normal sleep but primarily the result of the sedative effects of the opioid (Paqueron et al., 2002). Opioid doses should not be increased (titration should be stopped) in patients who are excessively sedated.
A multimodal approach that administers both acetaminophen and an NSAID preoperatively, or, at the latest, on admission to the PACU, will facilitate the management of pain in these high-risk and challenging patients.