Fausto Morell-Ducos
Dr Fausto Morell-Ducos is a consultant in anaesthesia and pain medicine at UCH, and an honorary lecturer at UCL. His specialist interests include complex pain management and opioid stewardship.
Location London
Activity
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Dear Dianna, thank you for your comments. You may find Step 2.8 regarding the concept of Number Needed to Treat (NNT) interesting with regards to your observations of how not all your patients respond to the analgesia you have provided. This also highlights the importance of multimodal analgesia. Thank you so much also for the feedback regarding the amount of...
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Fausto Morell-Ducos made a comment
Welcome back to Week 3!
We hope you have found the course interesting, engaging and useful so far. We have really enjoyed learning from your comments and insights too.
In this week, you will take a closer look at the concept of opioid stewardship. You will read about the practical changes you can make to your daily practice in order to make the use of...
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Fausto Morell-Ducos replied to Niamh Molloy
Dear Niamh, thank you for your comment. Yes, previously accepted approaches to the management of acute pain in patients who were already on buprenorphine advised stopping buprenorphine or changing this over to an alternative opioid due to concerns regarding its partial agonist action. More recent thinking, supported by some evidence, suggests that this is not...
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Dear Mina, this is a very good point. Giving opioids to pain intensity alone (unidimensional pain scores) and not taking into consideration functional outcomes, or other factors which influence pain experience such as anxiety, has been associated with increasing opioid use. We look at how we can practically assess pain multidimensionally in greater detail in...
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Thank you, Haris. Yes, the presence of psychological risk factors means the patient in Case 1 is at greater risk of developing persistent postoperative opioid use, however, as is illustrated in Case 2, any patient given opioids postoperatively can develop this complication. In the second case, the driver for the continued use of opioids is the development of...
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Fausto Morell-Ducos replied to Soleman Ranjous
Thank you, Soleman. Yes – the presence of mental health risk factors for persistent postoperative opioid use makes this outcome more likely in Case 1, however all patients given opioids after surgery are at risk. In Case 2, the patient develops a chronic pain syndrome postoperatively, which is in itself associated with increased risk of persistent opioid...
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Fausto Morell-Ducos replied to Tom Marshall
Thank you, Tom. You have raised some very relevant points. The duration of the prescription of opioids at discharge, and the lack of patient education on how to use opioid medication, are two important factors which can contribute to persistent opioid use after surgery.
In some settings it is thought that concern about the distances patients may have to...
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Fausto Morell-Ducos replied to keith miles
This is a really good point, Keith. There are practical considerations to having to review postoperative patients prior to issuing repeat prescriptions, which are very important, including availability of resources. However, as we are describing in these steps, not monitoring these patients can also have negative consequences. How to find this balance is one...
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Fausto Morell-Ducos replied to Laura Sarmiento
Welcome, Laura. Thank you so much for joining our course! We hope you find it interesting and useful, please let us know what you think :)
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Fausto Morell-Ducos replied to Akogwu Elaigwu
Welcome Akogwu, and thank you. We hope you find the course interesting!
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Fausto Morell-Ducos replied to Robert B
Welcome Robert! We hope you find the course interesting and practically useful in informing the care you deliver to your patients in the recovery area, and beyond.
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Fausto Morell-Ducos replied to Bhavana Binooj
Welcome Bhavana. We hope you find the course and the discussions insightful. We look forward to reading your comments!
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Fausto Morell-Ducos replied to Veronica Zachiteanu
Welcome Veronica! We hope you find the course and the discussions interesting.
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Fausto Morell-Ducos replied to Bamdad Aziz
Welcome, Bamdad! We hope you find the course interesting.
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Fausto Morell-Ducos replied to Vicki Addison
Welcome Vicki! It's great to have learners with prior knowledge and experience of implementing opioid stewardship. We'd be very keen to hear your views on the course content, as well as your experiences of applying the concepts we will discuss to your day-to-day practice.
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Fausto Morell-Ducos replied to Sandra Vijarona
Welcome Sandra! We hope you find the course useful in the care you deliver to your patients.
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Thank you so much for your comment, Alejandra. As you correctly state, this is another aspect of the global opioid crisis. Whilst many countries experience the consequences of excessive opioid prescription, access to pain relief when indicated can be limited and expensive in other regions. We explore these differences in access to opioid analgesia in greater...
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Fausto Morell-Ducos replied to Anna Simpson
Yes--you have touched on the main points of both cases, well done!
The first case illustrates how the presence of patient risk factors for persistent opioid use after surgery should help us to identify those patients most at risk, in order to monitor them more closely and pick up difficulties weaning opioids early. We will look at how this can be achieved...
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Fausto Morell-Ducos made a comment
Welcome to our new learners!
We are very excited to be launch this new course, and we are very much looking forward to exploring and discussing the main issues, advantages and disadvantages of using opioids around the time of surgery with you.
We really hope you find learning from the course useful, and we look forward to learning from you too. As...
