pain management Flashcards
pain
unpleasant physical and or emotional experience, associated with potential or actual tissue damage
analgesia
reduce perception of pain
nociception
experience of pain through the brains cerbral cortex
noxious stimuli
a stimulus that causes pain
noiciceptor
sensory receptor that responds to damaging or potentially damaging stimuli by sending electrical signals to the spinal cord and brain
pre emptive analgesia
pain relief given that is appropriate to the anticipated pain before procedure is carried out to prevent pain establishing
multimodal analgesia
the use of different classes of drugs in combination to desensitise multiple pain pathways
wind up
perceived increase in pain intensity overtime when a stimulus is delivered repeatedly above a critical rate
sensitisation
decrease in pain threshold and an increase in the magnitude of the response to noxious stimulation
hyperalgesia
an increased sensitivity to pain
transduction
translating noxious stimuli into nociceptive impulses
transmission
movement of impulses via nerve endings to spinal cord and then to the brain
modulation
process of amplification or dampening of nociceptive signals
perception
subjective experience of pain and how it is experienced
patient experience of pain
worsen experience during hospital stay, increase stress and fear
client experience of pain
added cost, admin of pain meds
recognition of pain - behavioural
restlessness
posture
gaurding
licking
lame
vocalisation
hiding
agression
decreased appetite
recognition of pain - physiological
tachycardia
hypertension
pupillary dialation
hyper salivation
hyperthermia
elevation in parameters
pain assesment
pain scoring
HR
vocilisation
movement
restlesness
treating pain
pre emptive pain relief
multimodal
reassess pain every 2-4hrs
opioid binding
bind to receptors in the CNS, GIT, urinary tract and smooth muscle
opioid receptors
mu, delta, kappa
full agonist
produce an effect when combined with a receptor
antagonist
do not produce an effect when combined with a receptor
partial agonist
produce some effect when combined with a receptor
mixed agonist and antagonist
has effect on some receptors but not on others
adverse effect of opioids
respiratory depression, reduced cough reflex, less responsive to co2 levels
increased intra cranial pressure - vasodialation
vomiting - stimulate chemoreceptor trigger zone
bradycardia
dogs- pin point pupils
cats-dialated pupils
histamine release
opioids licenced for use
morphine, fentynl, methadone, butorphanol, buprenorphine, naloxone
morphine
gold standard
high affinaty to mu receptor
class b controlled drug
4hr duration
SQ, IM, IV
fentaynl
full mu agonist
potent analgesic with short action
SQ, IM, IV, patches
class b controlled drug
methadone
full agonist
lasts 3-4hrs
no emetic effect
SQ, IM, IV
buprenorphine
partial mu agonist
mild-moderate analgesia
used in combinations
slow onset
lasts 6-8hrs
ceiling effect
class c controlled drug
naloxone
reverse effects of opioids
only used in overdose
NSAIDS
anti inflamatory, anti pyretic, analgesic
inhibitation of the COX enzyme
acute and chronic pain management
NSAIDS advantages
long duration
non behaviour modifying
lack of cardiopulmonary side effects
COX 1
maintain renal and gastrointestinal mucosal blood flow
aids platelet aggregation and blood clotting
COX 2
produce prostaglandins responsible for inflammatory response
adverse effects of NSAIDS
GI ulceration
v + d
kidney failure and acute renal failure
synergy with corticosteroids
NSAIDS contraindications
impared renal or hepatic function
dehydration
corticosteroids
GI ulcers
pregnant animals
NSAIDS licensed for use
carprofen
meloxicam
firocoxib
local blocks
dental nerve blocks
limb nerve blocks
infiltrative techniques
topical
intra articular
epidural
advantage of local regional analgesia
block transmission of pain
reduce dose of other drugs
minor sx in conscious animals
addition to GA
post op analgesia
potential complications of local regional analgesia
systemic toxicity if IV
nerve injury
block wrong nerve
local
lidocaine
mepivicaine
bupivicaine
ocular drops
can damage cornea if repeated
local transdermal patched
care with temp
dental blocks
infraorbital
mandibular
maxillary
limb nerve blocks
distal limb ring block
brachial plexus nerve block
sciatic nerve block
intra articular blocks
injected into a joint to treat joint pain
combined with steroid to reduce inflamation
hip
elbow
stifle
carpus
tarsus
epidural benefits
L6-L7 or L7-S1
combination of local and opioid
muscle relaxation
loss of hind limb motor function
long duration
cheap
epidural adverse effects
hypotension
urinary retention
accidental spinal anaesthesia
training required
gabapentin
anti anxiety
managment of neuropathic pain
ketamine
dissociative anaesthetic
analgesic properties
altered behaviour in recovery
