Pain Flashcards
Q1: What is post-operative pain management and why is it important?
A1: Post-operative pain management is a key responsibility of the junior doctor, essential for promoting recovery. Poor pain control can result in delayed recovery, complications like atelectasis or pneumonia, and decreased rehabilitation capacity.
Q2: How can post-operative pain be assessed?
2: Post-operative pain can be assessed subjectively, by asking the patient to grade their pain on a scale (e.g., mild, moderate, severe), and objectively, by observing signs like tachycardia, tachypnoea, hypertension, sweating, or agitation.
Q3: What are the potential consequences of poorly controlled post-operative pain?
A3: Poorly controlled pain can lead to slower recovery, reluctance to mobilize, inadequate ventilation (resulting in atelectasis and pneumonia), and decreased function and rehabilitation capacity.
Q4: What is the WHO Analgesic Ladder and how is it used in post-operative pain management?
A4: The WHO Analgesic Ladder provides a strategy for titrating pain relief, starting with simple analgesics (e.g., paracetamol, NSAIDs) and progressing to stronger opioids (e.g., morphine) if pain is not controlled. The goal is to tailor analgesia to the patient’s needs and reduce reliance on strong opioids as recovery progresses.
5: What are simple analgesics and what are their side effects?
5: Simple analgesics include paracetamol and NSAIDs (e.g., ibuprofen, diclofenac). Side effects of NSAIDs include gastric ulceration, renal impairment, asthma sensitivity, bleeding risk, and drug interactions (e.g., with warfarin). Long-term use may require a proton pump inhibitor (PPI).
6: What are the types of opiate analgesics and their side effects?
Opiate analgesics are classified into weak (e.g., codeine) and strong (e.g., morphine, oxycodone, fentanyl). Side effects include constipation, nausea, sedation, confusion, respiratory depression, pruritus, tolerance, and dependence.
7: How should opiate analgesics be prescribed?
A7: When prescribing opiates, always use regular paracetamol to reduce their requirement. Avoid combining weak and strong opiates. For patients with renal impairment, consider oxycodone or fentanyl over morphine.
Q8: What is patient-controlled analgesia (PCA) and when is it used?
8: PCA is an intravenous pump system that delivers a bolus dose of analgesic when the patient presses a button. It’s used when strong oral opiates are inadequate, offering tailored analgesia to the patient. PCA can be titrated for continuous infusions.
Q9: What are the advantages and disadvantages of PCA?
9: Advantages: Provides tailored analgesia, reduces overdose risk, and allows accurate tracking of opioid use. Disadvantages: Can be cumbersome, limiting mobility, and may not be suitable for patients with poor manual dexterity or severe learning difficulties.
Q10: What types of local anaesthesia can be used post-operatively?
A10: Local anaesthesia options include regional anaesthetic blocks (e.g., serratus anterior block for rib fractures), rectus sheath catheters, and spinal or epidural anaesthesia to aid post-operative recovery.
Q1: What is important to consider when choosing an antiemetic for post-operative nausea and vomiting (PONV)?
A1: The choice of antiemetic should be guided by the likely cause of the nausea. Multi-modal therapy, using different classes of antiemetics, is often more effective.
Q2: What pharmacological agents can be used for PONV in patients with impaired gastric emptying or gastric stasis
A2: In patients with impaired gastric emptying or gastric stasis, prokinetic agents such as metoclopramide (dopamine antagonist) or domperidone (dopamine antagonist) should be trialed, unless bowel obstruction is suspected.
3: What should be considered for treating PONV caused by metabolic or biochemical imbalances, such as uraemia or electrolyte imbalances?
A3: If metabolic or biochemical imbalances (e.g., uraemia or electrolyte imbalance) are suspected causes of PONV, metoclopramide (dopamine antagonist) can be trialed
Q4: What is typically used to treat opioid-induced PONV?
A4: Opioid-induced PONV typically responds well to ondansetron (5-HT3 receptor antagonist) or cyclizine (H1 histamine receptor antagonist).
