Pain Flashcards
Cancer pain caused by what. Physical and mental fx
Bone invasion, peripheral nerve compression. Loss of sleep and appetite, NV, anxiety, low self esteem, disfigurement
Pre op eval of pain
Pain hx, physical exam, self resport measurement scale, meds, doc
Control of postop pain beneficial why
Reduced stress response, shorter time to extubation/ICU stays, imp resp and bowel func, less risk DVTs/better mobilization, early d/c
Opioids: how they work, disadvantages
Mu and kappa receptors, gold standard in pain manage. Resp dep, low bp, NV, sedation, itching, urin ret
How NSAIDs work, use
Inhibit cox and prevent prostaglandin synthesis. Mild to mod pain d/t inflammation, opioid adjunct. Attenuated pain peripherally and SC
NSAID SE
Plt dysfunc, inhibit txa2- bleed, renal dysfunc, gi bleed, fx on bone healing, liver dysfunc
Acetaminophen: IV dose, rate, SE
Ofirmev 650-1000 mg q6h, max dose 4g 24 hrs. NV, HA, hepatotoxic
Dose: ketamine, tramadol
0.15-.25 mg/kg IV. 50 mg IV
Dose: Nubain, methadone
10-20 mg IV, 10-20 mg IV
Dose neurontin and Celebrex
900 mg PO, 400 mg PO
PN blocks where catheters can be places
Brachial plexus, femoral nerve, sciatic-popliteal intercostal, intrapleural
Benefits of neuraxial anesthesia
Better analgesia than systemic opioids, reduced stress response, GI motility return, dec pulm complic, dec coag related adverse events
Hydrophilic neuraxial opioids and about them
Morphine and dilaudid. Stay in CSF. Delayed onset, longer duration, high incidence SE
Lipophilic neuraxial opioids and about them
Fentanyl and sufentanil. Rapid onset, short dureation, minimal CSF spread, less SE
Neuraxial opioids
Morphine, fentanyl, sufentanil, demerol, dilaudid
LAs vs opioids in epidural
LA: high failure rate, motor block, hypotension. Opioids: less motor block and hypotension, resp depression and pruritis
LA plus opioids in epidural
Better choice. Limits regression of sensory block, less motor block, dec total dose LA.
LAs used for epidural
Lidocaine, bupivicaine, ropivicaine
Opioids used in epidural
Morphine, dilaudid, fentanyl, sufentanil
Adjuvants to neuraxial drugs
Clonidine (prolongs DOA, limited by lowering bp and hr and sedation). Epi and neosynephrine prolong block duration and intensity
Catheter insertion site for: thoracic surgery, upper abd/cholecystectomy, nephrectomy
T4-8. T6-8. T7-10.
Catheter insertion site for: lower abd, lower extremity
T8-11. L1-4.
Ambulatory pt pain consid
Postop pain prolongs stay. NV issue. Multimodal approach best
Elderly pt pain consid
Diff physio/pharmacodynamics/kinetics. Inc comorbitidies and dec physiologic reserves. Barriers to pain management. Regional may be best
Opioid tolerant pt goals
Provide baseline opioid reqs, anticipate inc in postop analgesia reqs, maximize use of adjunct drugs/consider regional
Ped pt pain management. Issues, encouraged, discouraged
Under tx, difficult assessment. Regional and pca encouraged. IM discouraged
Obesity/OSA high risk for what, goals
Pulm complic and resp arrest. Avoid resp depressants, epidural anes w/o opioids, nsaids, post op cpap
How TCAs help w pain
Elevate mood, help w sleep. Block reuptake of serotonin and NE. Potentiate narcotics.
TCAs dosing and SE
Smaller doses than depression dose, monitor levels. Anticholinergic: dry mouth, tired, ortho hypo, arrhythmias
Anticonvulsant drugs: how they work, SE
Alter ion channels along nerve fiber, block action potential and pain stimuli. Sedation, dizzy, ataxia
How alpha 2 agonists work
Clonidine and preceded, pre and post synaptically inhibit neuron firing in dorsal horn. Precedex also works centrally to inhibit release of sub P
How GABA agonists work
Inhibitory NT, acts in SC to prevent release of excitatory NTs. Baclofen
Sympathetic nerve blocks
Stellate block (cervicothoracic), thoracic sympathetic chain block, sphlanchnic, lumbar sympathetic, hypogastric plexus
Somatic nerve blocks
Trigeminal, facial, glossopharyngeal, occipital, phrenic, supraschpular, cervical/thoracic/lumbar paravertebral, trans sacral, pudendal
What neuroleptic blocks do, where they’re used, what is used int hem
Destroys nerve w alcohol and phenol. Lumbar sympathetic chain, celiac plexus, hypogastric plexus, ganglion impar (retroperitoneal), intercostal
How SC stim works, which conditions used for
Activates descending modulating sys, inhibits sympathetic outflow. Phantom limb pain, ischemic pain, PVD, SC lesions
Inadequate pain management in cancer due to what
Poor pain assessment, poor tx plan, lack of knowledge/analgesics, fear of addiction or resp depression
Steps of WHO analgesic ladder
1- mild pain, non opioids. 2- mild-most, weak opioids PO. 3- mod-severe, parenteral/potent opioids. 4- intractable pain, invasive therapy
Step 2 WHO meds
Codeine, hydrocodone, oxycodone, dihydrocodeine, tramadol
Step 3 who pain meds
Morphine, dilaudid, methadone, leborphanol, fentanyl, oxycodone
Cancer pain management adjuncts
Steroids (prevent prostaglandin release), psychotherapy, PT, antidepressants
