Basic Pain Management

Question 1

Mechanism of Pain

Answer 1

Periphery
-Tissue injury, release of chemicals, stimulation of pain receptors, pain travels in C nerve to spinal cord
Spinal cord
-Dorsal horn is first relay station, C nerve connects with second order nerve, travels up the opposite side
Brain
-Thalamus is second relay, connects to cortex, limbic and brainstem
Modulation
-Descending pathway from brain to dorsal horn, inhibits pain signals form periphery

Question 2

Reverse WHO ladder?

Answer 2

Start at top work down

Question 3

Local Anaesthetic MOA?

Answer 3

Works on internal membrane in axon to prevent depolarisation

Question 4

Types of Local Anaesthetics

Answer 4

Esters
-Procaine, amethocaine, cocaine, tetracaine
Amides
-Ropivacaine, levobupivicaine, mepicaine
EMLA(lignocaine:prilocaine) and Ametop(tetracaine 4%)

Question 5

Local Anaesthetics Max Dose

Answer 5

Lignocaine 3mg/kg, 7 with adrenalin
Bupivicaine/Levopbupivicaine 2,2
Prilocaine 6,9

Question 6

Convert 0.25% Lignocaine

Answer 6

Multiply by ten to get dose in 1ml (2.5mg/ml in this case)

Question 7

Symptoms of Local Anaesthesia Toxicity

Answer 7

Tingling sensation around mouth, ringing in ears, tonic-clonic seizure

Question 8

Where does spinal cord end in adults?

Answer 8

L1

Question 9

Where does subarachnoid space end?

Answer 9

S1

Question 10

Where can you do a spinal and epidural block?

Answer 10

Spinal
-L4/5, L3/4, L2/3
Epidural
-In theory, anywhere 
-Risk of cord damage if done above L1, usually

Question 11

Where does epidural space end?

Answer 11

Sacrococcygeal hiatus

Question 12

Epidural Needle Structures

Answer 12

Skin, subcutaneous fat, supraspinous ligament, interspinous ligament, ligament flavum