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anaesthetics > Pain Management > Flashcards

Pain Management Flashcards

1
Q

what are some of the adverse effects of pain?

A
  • sympathetic nerevous system activation –> increased myocardial oxygen demand
  • inability to deep breath –> atelectasis, chest infections, hypoxaemia
  • reduced mobility –> increased risk of DVT, PE, pressure sores
  • chronic pain problems
  • nausea/decreased GI motility
  • anxiety, fear, insomnia
  • increased catabolic hormones/decreased anabolic hormones –> hyperglycaemia
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2
Q

what is step 1 in WHO pain ladder?

A

paracetamol

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3
Q

what is step 2 of the WHO pain ladder?

A

paracetamol + codeine

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4
Q

what is step 3 of the WHO pain ladder?

A

paracetamol + morphine

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5
Q

name an example of local anaesthetic

A
  • bupivacaine
  • lidocaine
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6
Q

how long does local anaesthetic work for?

A

several hours

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7
Q

what will a nerve block do?

A

blockade of plexuses or peripheral nerves will provide selective analgesia in those parts of the body supplied by the plexus or nerves

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8
Q

what is local anaesthetic particularly useful?

A
  • surgical anaesthesia
  • post-operative pain relief
  • sympathetic block when spinal or epidural contraindicated
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9
Q

what is the purpose of spinal anaesthesia?

A
  • analgesia for surgery in the lower half of the body
  • pain relief lasting many hours after completion of the operation
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10
Q

what are the side-effects of spinal anaesthesia?

A
  • hypotension
  • sensory and motor block
  • nausea
  • urinary retention
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11
Q

how does an epidural anaesthetic work?

A
  • indwelling epidural catheter
  • provides a continuous infusion of analgesic agents
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12
Q

what are the disadvantages of epidural anaesthesia?

A
  • confine patients to bed
  • indwelling catheter required
  • epidural haematoma
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13
Q

when is epidural anaesthetic contraindicated?

A

coagulopathies

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14
Q

how is transverse abdominal plane block (TAP) set up?

A
  1. ultrasound is used to identify the correct muscle plane
  2. local anaesthetic (usually bupivicaine) is injected
  3. agent diffuses in the plane and blocks many of the spinal nerves
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15
Q

what is the preferred pain management technique for an extensive laparoscopic abdominal procedure?

A

transverse abdominal plane block (TAP)

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16
Q

what are the disadvantages of transverse abdominal plane block (TAP)?

A
  • duration of action is limited to the half-life of the local anaesthetic agent
  • some anaesthetists do not have the USS skills required to site the injections
17
Q

what is patient controlled analgesia (PCA)?

A

patients administer their own IV analgesia and titrate the dose to their own end-point of pain relief

18
Q

what drug is typically used in patient controlled analgesia?

A

morphine

19
Q

where is morphine metabolised?

A

liver

clearance reduced in liver disease, elderly and debilitated

20
Q

what are the side-effects of morphine?

A
  • nausea
  • vomiting
  • constipation
  • respiratory depression
21
Q

what is pethidine?

A

synthetic opioid which is structurally different from morphine but which has similar actions

22
Q

what is the toxic metabolite of pethidine?

A

norpethidine

23
Q

how is norpethidine excreted?

A

cleared by the kidney
accumulates in renal failure or following frequent and prolonged doses

24
Q

what are the signs of norpethidine build-up?

A
  • muscle twitching
  • convulsions
25
Q

how does paracetamol work?

A

inhibits prostaglandin synthesis

26
Q

what effects does paracetamol have?

A
  • analgesic
  • anti-pyretic
27
Q

where is paracetamol metabolised?

A

liver

28
Q

what effects do NSAIDs have?

A
  • analgesic
  • anti-inflammatory
29
Q

how does NSAIDs work?

A

inhibition of prostaglandin synthesis by the enzyme cyclooxygenase which catalyses the conversion of arachidonic acid to the various prostaglandins that are the chief mediators of inflammation

30
Q

what type of pain as NSAIDs particularly useful for?

A

superficial pain
* skin
* buccal mucosa
* joint surfaces
* bone

31
Q

what are the relative contraindications for NSAIDs?

A
  • history of peptic ulceration
  • GI bleeding
  • bleeding diathesis
  • operations associated with high blood loss
  • asthma
  • moderate to severe renal impairment
  • dehydration
  • hypersensitivity to NSAIDs or aspirin

anaesthetics (7 decks)

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