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Anesthesiology > Pain > Flashcards

Pain Flashcards

1
Q

Types of pain

A

Nociceptive (somatic and visceral) vs non-nociceptive (neuropathic and sympathetic)

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2
Q

Somatic pain

A

Somatic pain is musculoskeletal pain that is sharp and well localized.

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3
Q

Visceral pain

A

Visceral pain is internal organs/body cavities that is poorly localized, referred pain.

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4
Q

Pain is conducted along ___ pathways that transmit noxious stimuli from ___ to ___.

A

3 - neuron pathways.
periphery.
cerebral cortex.

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5
Q

Primary afferent neurons are located in the ___ which lie in the ___ at each spinal cord level.

A

Dorsal root ganglia.

vertebral foramina.

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6
Q

Each neuron has a single axon that bifurcates, sending one end to the __ and the other into the___

A

peripheral tissues it innervates

dorsal horn of the spinal cord.

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7
Q

In the dorsal horn, the primary afferent neuron synapses with a second order neuron whose axon ___ and then ___ to reach the ___

A

crosses the midline.
ascends in the contralateral. spinothalamic tract.
thalamus

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8
Q

Second order neurons synapse in the ___ nuclei with third order nuerons which send projections through the __ and ___ to the ___

A

thalamic nuclei.
internal capsule.
corona radiate.
postcentral gyrus of the cerebral cortex

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9
Q

protopathic =?

A

high-threshold receptors, respond to noxious stimuli, conducted by lightly myelinated A and C fibers

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10
Q

epicritic =?

A

Low-threshold receptors, respond to non-noxious/light touch, pressure, proprioception, and temperature, conducted by large myelinated fibers

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11
Q 
Visceral level innervation: 
Central diaphgram \_\_
Lungs\_\_\_
Heart\_\_\_
Aorta\_\_\_
Esophagus\_\_\_
A 
Central diaphgram: C4
Lungs: T2-T6
Heart: T1-T4
Aorta: T1-L2
Esophagus: T3-T8
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12
Q

Some inflammatory mediators directly activate____. Others act together to produce sensitization of ____

A

Nociceptors, evoking pain.
Somatosensory nervous system, which is characteristic for inflammatory pain, enabling easier activation of the pain pathway until tissue heals.

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13
Q

Inflammatory mediators:

A

bradykinin, TNF-alpha, IL-1, IL-8, Substance-P, calcitonin gene related peptide

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14
Q

Prostaglandins sensitize pain receptors by lowering the thershold of ____

A

polymodal nociceptors of C-fibers

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15
Q

Acute pain causes what respiratory system effects? With what adverse effects?

A
  1. Increased skeletal muscle tension
  2. Decreased total lung compliance

Adverse effects:

  1. Hypoxia, hypercapnia
  2. Ventilation-perfusion abnormality, atelectasis, pneumonitis
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16
Q

Acute pain causes what endocrine system effects?

With what adverse effects?

A
  1. Increased Adrenocorticotropic hormone
  2. Decreased Insulin, decreased testosterone
  3. Increased aldosterone and ADH
  4. Increased catecholamines
  5. Increased Angiotensin II

Adverse effects:

  1. Protein catabolism, lipolysis, hyperglycemia
  2. Decreased protein anabolism and sex drive
  3. Salt/water retention, CHF, edema
  4. Vasoconstriction, hypertension
  5. Increased myocardial contractility
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17
Q

Acute pain causes what cardiac effects?

With what adverse effects?

A

Increased Myocardial Work

Adverse effects: Dysrhythmias, angina, ischemia

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18
Q

Acute pain causes what GI effects?

With what adverse effects?

A

Enhanced sympathetic tone
Adverse effects:
Increases sphincter tone, decreases intestinal and urinary motility, hypersecretion of gastric acid, n/v/constipation

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19
Q

Acute pain causes what immunologic effects?

With what adverse effects?

A

Lymphopenia, depression of RES leukocytosis
Reduced Killer T-Cell cytotoxicity

Adverse effects:
Decreased immune function, increased susceptibility to infection

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20
Q

Acute pain causes what coagulation effects?

With what adverse effects?

A

Increased platelet adhesiveness, diminished fibrinolysis
Adverse effects:
Increased incidence of thromboembolic phenomena, reduced fibrinolysis

21
Q

Treatment of acute pain:

A

Oral or parenteral analgesics, peripheral nerve blocks, neuraxial blocks with local anesthetics, intraspinal opioids, adjunctive techniques such as TENS and physical therapy

22
Q

Non-pharmacologic modalities to treat acute injury?

A

Physical therapy, acupuncture, acupressure, elevation, ice, massage, heat

23
Q

Benefits of regional anesthesia

A

Safer, faster return of GI function, improved pulmonary mechanics, less n/v, shorter hospital stay, decreased cost, decreased DVT/PE risk, lower blood loss

24
Q

Peripheral Nerve blockade in pain management:

A

Can be intercostal, interpleural, brachial plexus, femoral nerve blocks with intermittent or continuous infusions of bupivacaine/ropivacaine.

25
Q

What approach to brachial plexus block for shoulder surgery, upper to mid-humeral surgery, and shoulder manipulation?

A

Interscalene approach

26
Q

What block for mid-humerus and distal surgery, pain relief in mid to distal arm, and hand surgery.

A

Intraclavicular

27
Q

Femoral block insertion site should be___

A

1.5-2 cm lateral to femoral pulse, 2 cm inferior to a line drawn b/w the pubic symphysis and the anterior superior iliac spine.

28
Q

Femoral block is indicated for___

A

knee surgery/mobilization and medial ankle surgery

29
Q

Sciatic nerve block is indicated for___

A

posterior approach at PSIS, for mid to lower thigh surgery, adjunct to knee surgery, ankle surgery.

30
Q

Rate of systemic absorption is proportionate to the ___ of the site of injection:

A

Vascularity.

IV > tracheal > intercostal > caudal > paracervical > epidural > brachial plexus > sciatic > subcutaneous

31
Q

Duration of action is correlated to ____ with ___ having longer duration of action.

A

Lipid solubility. Highly lipid-soluble.

32
Q

NSAIDs work how?

A

Inhibit prostaglandin synthesis (COX). Cox-1 is constitutive and widespread throughout the body, but COX-2 is expressed primarily with inflammation (and do not interfere with platelet aggregation) *Important

33
Q

Acetaminophen works how?

A

Acts as cyclooxygenase (COX) inhibitor, but poor ability to inhibit COX in the presence of high concentrations of peroxides which are found at sites of inflammation. Is an analgesic, antipyretic, can have renal/liver toxicity, but weak if any anti-inflammatory effects

34
Q

Opioids work how?

A

As mu-receptor agonists. Good for moderate post-op pain. Commonly combined with COX inhibitors to enhance analgesia and decreases side effects.
Many opioids undergo hepatic biotransformation and conjugation before renal elimination. (Codeine transformed to morphine)

35
Q

What is MEAC?

A

minimum effective analgesic concentration = the specific blood level at which opioid analgesia is achieved for each patient for a given pain intensity.

36
Q

Small increases about MEAC produce ___ in analgesia

A

large increases

37
Q

How does opioid action in the spine effect the dorsal root?

A

Presynaptically μ and δ receptors inhibit calcium influx to prevent release of glutamate, neuropeptides, substance P, and calcitonin gene-related peptide. Postsynaptically hyperpolarize ascending projection neurons.

38
Q

How does gabapentin work?

A

As an anti-convulsant by binding to Ca2+ channels to reduce flux and modulate gabergic neurotransmission. Useful in patients with neuropathic pain.

39
Q

What are adverse effects of gabapentin?

A

dizziness, somnolence, headache, ataxia, fatigue

40
Q

Katamine

A

NMDA antagonist

41
Q

How do local anesthetics work?

A

Act by blocking fast Na channels. Direct infiltration of an incision or a field block with local anesthetic that is long-acting such as bupivacaine.

42
Q

Contraindication of local anesthetic?

A

coagulopathy/platelet abnormalities, presence of infection or tumor at site of puncture. The presence of systemic infection is only a relative contraindication unless bacteremia is documented

43
Q

Acute pain is due to ___

A

nociception (specialized receptors that transduce noxious stimuli) or noxious stimuli due to injury, disease, or abnormal function of muscle/viscera. Can use opioids, local anesthetic, NSAIDS, etc.

44
Q

Chronic pain =?

A

Pain that persists beyond the usual course of an acute disease. May be due to nociception or neuropathic or both but in which psychological and behavioral factors often play a major role.

45
Q

Peripheral mechanisms of chronic pain:

A

spontaneous discharges, sensitization of receptors to mechanical, thermal, and chemical stimuli, up-regulation of adrenergic receptors, neural inflammation

46
Q

Treat chronic pain with ?

A

anticonvulsants, antidepressants.

47
Q

What are some of the pitfalls in treating a chronic pain complaint with opioids?

A

Opioids are not very effective with neuropathic pain.

Will develop tolerance and dependence in chronic pain.

48
Q

neuropathic pain =?

A

Involves peripheral-central and central neural mechanisms that are complex and generally associated with partial or complete lesions of peripheral nerves, dorsal root ganglia, nerve roots, or more central structures. Result of injury or acquired abnormalities of peripheral or central neural structures. Classically paroxysmal and lancinating with a burning quality. Associated with hyperpathia, increased response to mild stimulation, perception of an ordinarily nonnoxious stimulus as pain, and persistence of the sensation after the stimulus

Anesthesiology (9 decks)

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