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Surgery M4 part 1 > Pain Management > Flashcards

Pain Management Flashcards

1
Q

What is acute pain?

A

normal predicted physiological response to adverse stimulus that RESOLVES WITHIN 1 MONTH

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2
Q

What is chronic pain?

A

poorly managed acute pain that can produce pathophysiologic processes

  • caused by sensitization of the nervous system due to neuroplastic changes resulting in allodynia & hyperalgesia
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3
Q

What surgical procedures are associated with chronic pain?

A

amputation of a limb
lateral thoracotomy
inguinal herniorrhaphy

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4
Q

What do we call a painful response to a non-painful stimulus?

A

allodynia

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5
Q

what is hyperalgesia?

A

an exaggerated pain response to a normally painful stimulus

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6
Q

What are nociceptors?

A

free nerve endings (first order neuron)

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7
Q

What fibers transmit first pain?

A

A-delta fibers

  • sharp or stinging pain well localized
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8
Q

which fibers transmit second pain?

A

C fibers

diffuse pain

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9
Q

What is the difference between nociceptive pain & neuropathic pain?

A

NOCICEPTIVE NEUROPATHIC
- doesn’t cause nerve - injury or malfunction in the
damage peripheral or central
nervous system
- acute pain - chronic pain
- somatic: localized
or visceral: diffuse

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10
Q

What is the pain pathway?

A 
1- stimulus 
2- nerve ending
3- spinal cord ---> crossover 
4- spino-thalamic tract (thalamus)
5- sensory cortex
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11
Q

How does the body process pain?

A

1- transduction: stimuli converted to action potential
2- transmission: action potential conducted through
nervous system
3- modulation: altering neural transmission
- inhibition or augmentation of pain signals
4- perception: integration of painful input into
somatosensory & limbic cortices

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12
Q

What is the point of preventive analgesia?

A

block the development of sustained pain to prevent chronic pain

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13
Q

What type of pain is postoperative pain?

A

nociceptive

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14
Q

What is the best method of treating nociceptive (acute) pain?

A
  • opioids

- NSAIDS

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15
Q

How should mild pain be treated?

A

nonopiod +/- adjuvant therapy

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16
Q

How should mild to moderate pain be treated?

A

weak opioid +/- nonopioid +/- adjuvant therapy

17
Q

How should moderate to severe pain be treated?

A

strong opioid +/- nonopioid +/- adjuvant therapy

18
Q

What is the aim of multimodal analgesia?

A
  • improves pain relief

- reduces opioid requirement & adverse effects

19
Q

What analgesics are used in multimodal analgesia?

A
  • opioid
  • NSAID
  • paracetamol
  • local anesthesia
20
Q

What is the acute pain service (APS)?

A
  • a team providing pain service for post-op patients
    - anesthesiologist
    - surgeons
    - nurses
    - pharmacist
    - physiotherapist
21
Q

what are the analgesics that work on the level of the cortex?

A
  • opioids
  • alpha2 agonists (pesidex)
  • acetominophen
  • anticonvulsants
  • NMDA antagonists (KETAMINE at low dose)
22
Q

What are the analgesics that work at the level of the trauma?

A
  • anti-inflammatory drugs

- local anesthetics

23
Q

What are the analgesics that work on the level of the peripheral nerve (first order)?

A

local anesthesia

24
Q

What are the analgesics that work at the level of the dorsal horn (second order neuron)?

A
  • opioids

- local anesthesia

25
Q

What is the gold standard for treatment of acute post-op pain?

A

morphine

26
Q

Why is pethidine no longer used?

A

highly addictive

27
Q

which opioid has the fastest onset?

A

fentanyl

has a short duration of action (45mins)

28
Q

What are the adverse effects of opioids?

A
  • nausea, vomiting, constipation
  • urinary retention
  • delirium, hallucinations, sedation
  • respiratory depression
29
Q

What is the function of NSAIDs?

A

voltarine & ibuprofen

  • inhibit COX enzymes thus decrease the production of prostaglandin E2
30
Q

What is the function of prostaglandin E2?

A

key mediator of peripheral & central pain sensitization

31
Q

What are the side effects of old NSAIDs?

A
  • platelet dysfunction
  • gastrointestinal ulceration
  • risk of nephrotoxicity
32
Q

What is the function of paracetamol?

A

analgesic & antipyretic

centrally acting inhibitor of COX enzyme

33
Q

What are the other nonopioid analgesic adjuncts?

A
  • ketamine at very low doses
  • lidocaine infusion
  • dexmedetomidine
  • gabapentin (anticonvulsant)

Surgery M4 part 1 (47 decks)

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