day 4 - Acute Pain Management

Question 1

define pain

Answer 1

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Question 2

who pain ladder

Answer 2

“Pain ladder”, or analgesic ladder, was originated by the World Health Organization (WHO) to describe its guideline for the use of drugs in the management of pain. It was originally applied to the management of cancer pain, but is now widely used by medical professionals for the management of all types of pain.

The general principle is to start with first step drugs, and then to climb the ladder if pain is still present. The medications range from household, over-the-counter drugs with minimal side-effects at the lowest rung, to powerful opioids.

Bottom rung of ladder (mild pain): Non opioid +/- adjuvant
Middle rung of ladder (moderate pain): Weak opioid +/- non opioid +/- adjuvant
Highest rung of ladder (severe pain): Strong opioid +/- non opioid +/- adjuvant

Question 3

Acute Pain Analgesic Staircase

Answer 3

Stage 1: Immediately post-operative Strong opioid e.g. morphine sc,im,iv or PCA or epidural opioid/ local anaesthetic infusion +/- non-opioid analgesic

 Stage 2: Oral opioid for moderate to strong pain +/- non-opioid analgesic( NSAID)

 Stage 3: Prior to discharge      Non-opioid analgesic

Question 4

Non-opioid Analgesics

Answer 4

Paracetamol: Acetaminophen centrally acting 1g 6h or 15-20mg/kg for children
 Diclofenac sodium: 50mg TDS orally
 SE: Prostaglandin and prostacyclin effect
 Ibuprofen, diclofenac, naproxen, piroxicam
 COX 1 and COX 2


Question 5

Compound Analgesics

Answer 5

 Co-Proxamol: Paracetamol 325mg, Dextropropoxyphene 32.5mg

 Co-Dydramol: Paracetamol 500mg,Dihydrocodeine 10mg

 Co-Codamol: Paracetamol 500mg, Codeine phosphate 8mg

 Aspav: Aspirin 500mg and opium alkaloids

Question 6

Weak opioids

Answer 6

Dihydrocodeine 30mg 4 hrly po

Tramadol weak iv,po agonist 50-100mg

Buprenorphine 200-400mcg sl 4-6h

Codeine phosphate 30- 60mg 4h

Question 7

Strong opioids

Answer 7

Morphine
Fentanyl
Oxycodone
Diamorphine

Question 8

Local Anaesthetic Techniques

Answer 8

Local anaesthetics are either esters or amides
 Influence action potential along the nerve
 Local infiltration
 Nerve block/ Plexus block with ultrasound
guidance
 Caudal/ epidural/spinal analgesia