Pelvic Fracture in Chronic Pain Patient with Anxiety

You are asked to review a 43-year-old woman who fell from her horse 24 hours ago and sustained an isolated displaced pelvic fracture. She was transferred in a stable condition from a regional hospital and is booked for anterior intrapelvic fixation in the emergency theatre tomorrow. Medical History Gastro-oesophageal reflux disease Severe anxiety Longstanding lower back pain and coccygeal pain Medications Amitriptyline 20 mg nocte Duloxetine 60 mg once daily Medicinal cannabis (sublingual CBD oil) 40 mg nocte Meloxicam 15 mg once daily Oxycodone SR 40 mg bd Oxycodone IR as required, up to 40mg daily Pantoprazole 40 mg once daily Tramadol SR 150 mg bd Observations Weight 60 kg Height 165 cm BMI 22 kg/m2 The patient is not mobile and has severe pain, which she states has been poorly managed. She has significant anxiety related to her impending procedure. You are asked to see her on the ward to assist with the management of her pain which is causing significant behavioural issues.