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
How does paracetamol work?
COX 3 inhibition in the CNS, decreasing prostaglandins thereby increasing the pain threshold
What can excessive use of paracetamol cause?
liver damage
How do NSAIDs work?
inhibits non-selective COX1 and COX2, decreasing prostaglandins synthesis, increasing the pain threshold
What are the risks associated with NSAIDs?
affects COX of other organs : kidneys, stomach, heart complications risk of bleeding stomach ulcers
What are opiods mode of action?
agonist of opiod receptors
weak opiod?
codeine
moderate opioid?
tramadol
strong opioid?
morphine
main risk of opiod?
Decreased respiration
Dose of paractemol?
500mg - 1g every 4-6hrs, maximum 4g a day
dose of ibuprofen?
400mg every 4-6hrs, maximum 2.4g a day
Dose of codeine?
30-60mg every 4-6hrs
What are some indications of sedation?
- anxiety due to past experiences
- unpleasant prolonged procedure
- medical conditions that may be aggravated by stress
- behavioural conditions
- special care
what is IOSN (Indicator of sedation need) graded on?
- anxiety
- medical history
- treatment complexity
Main steps in the management of anxiety?
- behavioural management
- inhalation sedation
- intravenous sedation
- general anaesthetic
What is conscious sedation?
A technique in which the use of a drug produces a state of depression of the CNS enabling treatment to be carried out, during which verbal contact with the patient is maintained throughout
What chemical is used in inhalation sedation?
Nitrous oxide and oxygen
What is the recovery period for inhalation sedation?
10 mins
What chemical is used in intravenous sedation?
Sedative midazolam given into vein
What is the recovery period for intravenous sedation?
20-40 minutes
What must you not have before intravenous sedation?
alcohol or recreational drugs
What is the antidote of sedative midazolam?
flumazenil
Drugs which prolong the effect of sedation
- protease inhibitors
- nefazodone
- sertraline
- grapefruit
- fluoxetine
- erythromycin
- diltiazem
- clarithromycin
Drugs which reduce the effect of sedation
- rifapentine
- rifabutin
- phenytoin
Drugs which enhance the sedative effect
- antidepressants
- antiepileptic
- opioids
- antipsychotics
- alcohol
- some antihitamines
What are 3 other types of sedation?
- oral
- intramuscular
- rectal
What is oral sedation
benzodiazepine, easy to administer but difficult to control
