Analgesia

Question 1

How does pain affect surgery outcomes

Answer 1

• Autonomic activation → arteriolar constriction →
↓ wound perfusion → impaired wound healing

• Decreased mobilisation → ↑ risk of VTE and ↓ function

• Decreased respiratory excursion and ↓ cough →
atelectasis and pneumonia

Question 2

End op analgesia

Answer 2

• Infiltrate wound edge with local anaesthetic

* Infiltrate major regional nerves with local anaesthetic

Question 3

Pre-op

Answer 3

Epidural - bupivacaine

Question 4

Post-Op stepwise approach

Answer 4

1. Non-opioid ± adjuvants
   - Paracetamol
   - NSAIDs - Ibuprofen or diclofenac IM
2. Weak opioid + non-opioid ± adjuvants
   - Codeine
   - Dihydrocodeine
   - Tramadol
3. Strong opioid + non-opioid ± adjuvants
   - Morphine
   - Oxycodone
   - Fentanyl

Question 5

Spinal or Epidural Anaesthesia

Answer 5

• ↓ SE as drugs more localised

* 1st line for major bowel resection

Question 6

Caution with spinal or epidural anaesthesia

Answer 6

• Respiratory depression

- Neurogenic shock → ↓BP