In a patient with Type B aortic dissection requiring stabilization, what is the next most appropriate therapeutic intervention if pain continues despite esmolol infusion?

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In managing Type B aortic dissection, the primary goals are to control blood pressure and heart rate to minimize stress on the arterial wall, as well as to manage pain effectively. If a patient continues to experience significant pain despite receiving an esmolol infusion, which is a beta-blocker that effectively decreases heart rate and blood pressure, the next step focuses on adequately addressing the patient's pain to improve comfort and potentially reduce sympathetic stimulation that can exacerbate the condition.

In this scenario, utilizing hydromorphone for patient-controlled analgesia (PCA) helps to manage the persistent pain effectively. PCA allows patients to administer their own pain relief within prescribed limits, ensuring they receive adequate pain control tailored to their subjective experience. This is critical in the context of aortic dissection, as severe pain can increase sympathetic outflow, worsening blood pressure and heart rate, thereby putting additional stress on an already compromised aortic wall.

Other options, while they play roles in managing blood pressure and related symptoms, do not directly address the patient's acute pain in this scenario. For instance, while calcium channel blockers like nicardipine or diltiazem may help with blood pressure control and can have a role in managing heart rate, they do not provide the same level

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