4.2 Chronic Post-Surgical Pain Flashcards
1
Q
Define CPSP
A
- New pain
- Developing after surgical procedure
- Lasting at least 2 consecutive months
with other explanation excluded
(malignant / infection) - Cannot be pre-existing pain
2
Q
Risk factors
A
Preop
Intraop
Post op
3
Q
Preop
A
- Pre-operative pain of any nature
severe/chronic - Younger age group
- Genetic predisposition
less efficient endogenous modulation
Pain signal and central processing - Anxiety of fear or surgery
- Enhanced preop pain sensitve
4
Q
Intraop
A
- Long Complex surgery
- Nature surgery
- amputation
- sternotomy
- inguinal hernia repair
- thoractomy - Prev thought related nerve injury during
doesnt appear consistently - Open v closed
- Repeat surgery
especially when repeated <1y
5
Q
Post operative
A
- Severity of postoperative pain
significant indicator for development CPSP - Poor response to analgesic regimen
provided postop
6
Q
Techniques to reduce severity and Incidence CPSP
Preoperative
A
Preoperative
- Id high risk surgery + patients
- Preemptive analgesia along little benefit
- Guided image therapy
some benefit
decreasing severity / duration / incidence
modulating psychosocial factors related to perception
7
Q
Techniques to reduce severity and Incidence CPSP
Intraoperative
A
- RA commenced perop
and continued
significantly reduce incidence CPSP - Gabapentin admin
perio - no effect incidence in amputation
When combined LA in breast surgery
CPSP fell
- IV ketamine infusions
varying success
8
Q
Intra-operative
A
- Clonidine added to RA
prolong block, reduce post op pain
CPSP incidence - Limited data
multimodal strat
reduce incidence
multiple therapy reduce or precent
9
Q
Post-Operative
A
Aggresive and Effective post op analgesia
Patients w/ breakthrough pain
- Develop symptoms suggestive neuropathic
Rx agents like gabapentin
Long term effect CPSP unknown
