Pain Flashcards
Dose for intralipid
1.5ml/kg over 1 minute then 0.25ml/kg infusion
Block for pelvic cancer pain
superior hypogastric plexus block
Advantages with epidurals
fewer DVTs
better pain
fewer side effects
Last dose of heparin to remove epidural
UFH = 4-6 hours
LMWH day = 12 hours
Higher doses = remove before starting therapy and wait 24 hours
How does warfarin work?
blocks factors 2, 7, 9, and 10, Protein C, S
How do you reverse warfarin?
Vit K
FFP
Factor concentrate (K-centra 4 factor concentrate)
Ways to prevent LAST
Limit dose given Use ultrasound Small incremental doses Addition of epi or fent as markers of systemic absorption Avoid excessive sedation
Max dose of bupivicaine
2.5 - 3mg/kg
Max dose of lidocaine and mepivicaine
5 - 7mg/kg
Max dose if ropivicaine
2.5 - 3.5mg/kg
Pancreatic cancer pain not controlled with MSContin, what are you other options?
Adjuvant therapies - anticonvulsants, antidepressants Corticosteroids Opioid rotation TENS Celiac plexus block
Where is the celiac plexus located?
Anterior body of L1
What are the complications of a celiac plexus block?
Paralysis Postural hypotension Retroperitoneal hemorrhage Intravascular injection Diarrhea
What are the diagnostic criteria for CRPS-1?
Noxious event Burning pain, allodynia or hyperalgesia Cyanosis Edema Sweating Skin changes
Hows does CRPS-2 differ from CRPS-1?
By nature of injury
1 = crush, laceration, fractures, surgery, burn, sprains
2 = nerve injury
Complications of stellate ganglion block?
Expect Horners syndrome - good block
- myosis, ptosis, anhydrosis, nasal stuffiness
Intrathecal, epidural, intravascular injection
transverse process of C6
UL inc temperature
Dx and Tx of UL CRPS
Mechanism for peripheral nerve sensitization? Central sensitization?
Peripheral - inflammatory mediators sensitize nerves
Central - lower threshold for pain + allodynia + hyperesthesia
What are trigger points?
Hyperirritable nodules in muscle + focal point tenderness
How does TENS therapy work?
Inhibition of pain signals at presynaptic level
Release of endogenous substances involved in pain control
What is the treatment for phantom limb pain?
Spinal cord stim Heat Acupuncture PT Hypnosis Biofeedback Antidepressants Anticonvulsants
How would you treat opioid withdrawal?
Tx any dehydration Clonidine Anti-emetic Anti-diarrheal Addiction specialist
Do you need to intubate pt with seizure from suspect LAST?
Probably.
I would want to avoid acidosis, hypoxia which enhance the cardio-depressant effects of LAs. (increase free fraction of LAs)
How would you distinguish opioid requirements from addiction? Tolerance? Dependence?
I would assess for compulsive behaviors suggestive of cravings, harmful effects of use like failure to meet work or family obligations
Tolerance
- Need for escalating doses for same clinical response
Dependence
- Patient still has control over use but experiences withdrawn without the medication
