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AS - N928 Basic Principles of Anesthesia > Acute Postop Pain > Flashcards

Acute Postop Pain Flashcards

1
Q

Pain

A

5th vital sign
Unpleasant sensory & emotional experience associated w/ actual or potential tissue damage
Consistent w/ tissue injury degree

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2
Q

Acute Pain

A 
Short duration
<6 weeks
Known cause
Temporary & located in area trauma or damage
Resolves spontaneously w/ healing
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3
Q

Chronic Pain

A

Persists beyond normal recovery duration from acute injury or disease
Cause not always identifiable
Affects patient self-image & well-being

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4
Q

Neuropathic Pain

A

Abnormal or unfamiliar pain
CNS or PNS dysfunction - injury or acquired abnormalities
Central pain d/t injury to brain or spinal cord (phantom pain)
Peripheral originates in nerve root, plexus, or nerve

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5
Q

Idiopathic Pain

A

Pain not attributable to identifiable physical or psychological cause
Perception - excessive pain

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6
Q

Psychogenic Pain

A

Sustained via psychological factors

Effective & behavioral disturbances

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7
Q

Nociceptive Pain

A

Appropriate response to identifiable tissue damage

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8
Q

Nociception

A

Noxious stimuli detection, transduction, & transmission

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9
Q

Transduction

A

Stimuli translated into electrical energy at the site

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10
Q

Transmission

A

Impulse propagation via the nervous system

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11
Q

Modulation

A

Stimuli alteration

Amplified or attenuation

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12
Q

Perception

A

Based on patient’s psychological framework

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13
Q

Somatic

A

Superficial arises from skin, subcutaneous tissues, & mucous membranes

  • Sharp, pricking, throbbing, or burning
  • Well localized

Deep arises from muscles, tendons, joints, or bones
- Dull, aching & less localized

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14
Q

Visceral

A

Internal organ disease process or abnormal function

Localized or referred

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15
Q

Allodynia

A

Ordinarily non-noxious stimulus perceived as pain

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16
Q

Analgesia

A

Absence pain perception

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17
Q

Anesthesia

A

Absence all sensation

18
Q

Hyperalgesia

A

Exaggerated response to noxious stimuli

19
Q

Neuralgia

A

Pain in nerve distribution

20
Q

Paresthesia

A

Abnormal sensation perceived w/o stimulus

21
Q

Radiculopathy

A

Functional abnormality 1+ nerve roots

22
Q

Class A α

A 
Peripheral afferent nerve fibers 
Large myelinated fibers
Low activation threshold
Diameter 1-20μm 
ALPHA
Conduction impulse 60-120m/s
Transmits motor & proprioceptive impulses
23
Q

Class A β

A 
Peripheral afferent nerve fibers 
Large myelinated fibers
Low activation threshold
Diameter 1-20μm 
BETA
Conduction impulse 60-120m/s
Cutaneous touch & pressure
24
Q

Class A δ

A 
Peripheral afferent nerve fibers 
Large myelinated fibers
Low activation threshold
Diameter 1-20μm 
DELTA
Conduction impulse 5-25m/s
Mediates pain sensation
- Transmits fast or first pain
- Sharp, stinging, pricking
Glutamate binds to NMDA receptors
25
Q

Class A γ

A 
Peripheral afferent nerve fibers 
Large myelinated fibers
Low activation threshold
Diameter 1-20μm 
GAMMA
Conduction impulse 5-25m/s
Cutaneous touch & pressure
26
Q

Class B

A

Peripheral afferent nerve fibers
Medium-sized myelinated fibers
Higher threshold (lower excitability) than Class A & lower threshold than Class C fibers
Diameter <3μm
Conduction speed 3-14m/s
Post-ganglionic sympathetic & visceral afferents

27
Q

Class C

A 
Peripheral afferent nerve fibers 
Un-myelinated or thin myelination
Diameter 0.4-1.2μm
Conduction speed 0.5-2m/s
Pre-ganglionic autonomic & pain fibers
- Transmits slow or second pain
- Burning, persistent, aching, throbbing pain
Substance P binds to NK-1 receptors
28
Q

Pain Modulation

A

Descending dorsolateral spinal tract

29
Q

Supraspinal Analgesia

A

Mu-1 receptors
Limbic system, hypothalamus, & thalamus
IV opioids

30
Q

Spinal Analgesia

A

Mu-2 receptors
Periventricular/periaqueductal grey
IV & neuraxial opioids

31
Q

Surgical Stress Response

A

CV ↑HR/CO ↑BP ↑SVR (angiotensin II) ↑MVO2
Resp ↑O2 consumption ↑CO2 production ↑minute ventilation ↑WOB ↓chest expansion d/t pain → atelectasis, intra-pulmonary shunting, hypoxemia, & hypoventilation
Endocrine ↑glucagon ↓insulin ↑epinephrine → vasoconstriction ↑myocardial contractility ↑cortisol & catecholamines → RAAS activation (Na+ & H2O retention)
GI ↑sphincter tone ↓VSMC tone → ileus or PONV
↑gastric acid production → stress ulcers
Immune - leukocytosis w/ lymphopenia ↓RAS → infection risk
Heme ↑platelet adhesiveness ↓fibrinolysis → hypercoagulable state

32
Q

Opioid-Induced Hyperalgesia

A

Diminished pain threshold & enhanced pain sensitivity

33
Q

Multi-Modal Approach

A 
NSAIDs
Ketamine
Methadone
Anticonvulsants
Dexmedetomidine
Clonidine
Magnesium
Glucocorticoids
Local anesthetics
Regional anesthesia
34
Q

NSAIDs

A

Effective to treat mild to moderate pain
Adverse effects include GI bleeding, acute renal failure, & hepatotoxicity
Caution in elderly patients d/t ↑risk renal impairment

35
Q

Ketamine

A

NMDA antagonist
Bolus 0.5mg/kg
Infusion 4mcg/kg/min

36
Q

Methadone

A

D-isomer NMDA antagonist

0.2mg/kg

37
Q

Anticonvulsants

A

Pregabalin & Gabapentin
Manage spontaneously firing sensory neurons associated w/ neuropathic pain
- Attenuate neuronal sensitization response

38
Q

α2 Agonists

A

Dexmedetomidine
Clonidine
RISK BRADYCARDIA & HYPOTENSION

39
Q

Acetaminophen

A

15mg/kg

40
Q

Glucocorticoids

A

Anti-inflammatory + PONV

41
Q

Regional Anesthesia

A 
Peripheral nerve blocks 
- Lumbar plexus 
- Interscalene
Central neuraxial blocks 
- Spinal
- Epidural
42
Q

Neuraxial Opioid Side Effects

A 
Itching (most common)
Nausea
Urinary retention
Respiratory depression (early & late)
Sedation
CNS excitation
Neonatal morbidity

AS - N928 Basic Principles of Anesthesia (18 decks)

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