27- Pain and anxiety management Flashcards
What is pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage
What is nociception?
The ability to sense pain (by receptors that translate noxious stimuli to the brain)
What is a condition the means a person is unable to detect pain?
Congenital Analgesia
Why is pain important
To protect form danger/death
What are the 3 main noxious stimuli?
- Mechanical noxious stimuli
- Thermal noxious stimuli
- Chemical noxious stimuli
What are the 3 types of pain fibres?
C fibres- non-mylenated
A alpha and A delta - myelnated
Which pain fibres are for dull pain?
c fibres
Which fibres are for sharp shooting pain?
A alpha and A delta due to their myelnation
When should patient pain be managed?
Preoperatively, intraoperatively, postoperatively
Ways of preoperative management
ICE (ideas, concerns, expectations)
good planning with patient
pre-op tests/assessment
Ways of intraoperative pain management
Local Anaesthesia
What are the 2 main groups of LA
- Amino-esters
2. Amin-amides
Which LA would you give to pt with liver disease?
Amino-esters (they break down in the plasma)
What should you check on a cartridge before you use
- correct medication
- no damage
- no bubbles
- no cloudiness
- expiration date
What is adrenaline
Hormone that helps give more profound anaesthesia by prolonging duration and reducing toxicity
What is felypressin
A synthetic octapeptide, not as effective as adrenaline poorer haemorrhage control
What is adrenaline contraindicated with?
- unstable angina
- hypertension
- taking monoamine oxidase inhibitors (MAOI)
What different types of LA are there?
- Lidocaine with adrenaline
- Articaine with adrenaline
- Prilocaine with felypressin
- Bupivacaine with adrenaline
Local complications of LA
- Nerve damage
- Motor nerve paralysis
- Trismus
- Intravascular Injection
Systemic complications of LA
- Allergy
- Infection
- Toxicity
- Drug interaction
What does topical anaesthesia contain?
20% benzocaine, 2.5-10% Lidocaine
Ways of post-operative pain management
using analgesia agents: -paractemol, NSAIDs, Opioids
What do we want to prevent by carrying out postoperative pain management?
1- periferal sensitization
2- central sensitization
What will adequate pre/intra/post management do?
- reduce input to spinal cord
- minimise spinal cord changes
- prevent cortex reorganisation
- reduce postoperative pain
- improve patients experience
