Chronic Pelvic Pain with Opioid Burden and Serotonin Toxicity Risk

You receive a referral from the gynaecology registrar during your shift in the acute pain service. The patient is a 22-year-old woman with chronic pelvic pain. She had seven presentations to the emergency department with severe abdominal pain over the past few months. Her most recent pelvic ultrasound is normal and she had two negative diagnostic laparoscopies last month. During this admission she was on an intravenous ketamine infusion at a rate of 10 mg/hour for three days. The infusion was ceased a few hours ago. She also received intermittent doses of oral tramadol 100 mg four times daily and oxycodone 10 mg four hourly. She has been referred to the chronic pain service but has not yet been seen. Medical History Asthma Depression Medications Celecoxib 200 mg bd Clonazepam 1 mg once daily Clonidine 50 mcg qid Oxycodone/naloxone 40 mg/20 mg bd Paracetamol 1 g qid Salbutamol Inhaler as required Thyroxine 75 mcg once daily Venlafaxine 75 mg bd Observations Weight 65 kg Height 168 cm BMI 23 kg/m2 The gynaecology team is requesting a discharge analgesia plan for this patient.