Pain Flashcards
Pain is difficult to assess because it is SUBJECTIVE AND UNIQUE. It is influenced by:
unique physiology (peripheral and central nervous system circuitry)
pathophysiology (not one injury is exactly the same)
personality
previous life experience
cultural and religious background
age
Elements of Pain Assessment
P = precipitating events (What leads to the pain?) Q = quality (stabbing, burning, dull, etc.) R = region/radiation S = severity T = temporal relationship/timing A = associated symptoms --functional impairment --previous treatment --inflammation PAIN GOALS
Wong-Baker FACES scale: appropriate population
> 3 years old and up
Behavioral pain scales: appropriate populations
provides a means for consistent evaluation of pain in NON VERBAL patient populations
allows patients who cannot self report pain a method for pain assessment --pediatric patients, neonates, babies --pts with cognitive impairment --critically ill patients
Checklist of Non verbal pain indicators (CNPI): appropriate population
adults
Payden behavioral pain scale: appropriate population
- developed for critically ill, intubated ICU patients
- has reliability & validity & correlates to NPI ratings (even in pts who are on sedation)
- uses a 0-12 pain rating scale
FLACC pain scale: appropriate population
2 months to 7 years
CRIES pain scale: appropriate population
0 - 6 months
Nonpharmacologic treatment modalities
- acupuncture
- positioning
- immobilization
- heat/cold
- massage
- relaxation behaviors
- PT/rolling
- TENS
Pain: physical exam
general physical examination
examine affected area
neurological examination
musculoskeletal system examination (ROM, muscle wasting)
skin (redness, wounds, edema, temp changes)
assessment of psychological factors: unkept personal hygiene
vital signs: inc HR, BP, etc
Acute pain: definition
pain caused by noxious stimulation due to injury, trauma, an acute disease process, or abnormal function of muscle or viscera
almost always nociceptive pain –>results in neuroendocrine response
Pain management: why do it?
- reduction of the stress response
- shorter times to extubation, shorter ICU stay
- improved respiratory function
- earlier return of bowel function
- early mobilization, decreased risk of DVTs
- early d/c
- reduction in sensitization, neuroplasticity, wind up phenomenon, and transition to chronic pain
The best postoperative pain management begins when?
PREOPERATIVELY
Benefits of regional anesthesia
“patients do better overall”
- less morbidity
- less mortality
- less infections
- less urinary cortisol
- -regional at a site > L1 have a significant effect on the neuroendocrine response to surgery
- lower overall post op complication rate
Advantages of patient controlled analgesia (PCA)
cost effective
higher degree of pt satisfaction
total drug consumption is less than IM?
harder to over medicate self
PCAs prevent…
“the pain no pain cycle”
PCA use: findings
patients consume less drug
male use more than female
shortens hospital stays
ERAS protocols: pre hospital
pain management plan
ERAS protocols: pre operative
initiation of multimodal medications and regional block placement
ERAS protocols: intraoperative
short acting, opioid sparing medications
multimodal medications
regional anesthesia/analgesia
ERAS protocols: post operative
regional anesthesia
non opioid analgesics/NSAIDs
Pain management: peripheral nerve blocks
single injection or continuous infusion of local anesthetic applied at a peripheral nerve site
-can add opioid and/or steroids to mixture
can be used for intraop analgesia or as an adjunct to postoperative analgesia
limits the path of nociceptive impulses
superior analgesia
few side effects
can have analgesia for up to 24 hours after single injection
What is Exparel?
bupivicaine liposome injectable suspension
approved for single dose local infiltration and interscalene brachial plexus nerve blocks
lasts up to 96 hours post infiltration and 120 hours post peripheral nerve block
Exparel: side effects
nausea, fever, vomiting
