Pain Management Flashcards
Differentiate between acute and chronic pain
Acute pain- sudden onset usually specific to injury or illness
Lasts <3-6 months
Chronic pain- >3-6 months of persistent pain
Not related to malignancy
Prolonged stress response- has neg effect on body
And psychological aspect
Pain scales in neonate/ child and adult
Neonate- FLACC score
Facial expression
Legs movement
Activity level
Cry
Consolibility
Child- faces images happy to crying
Adults
Pain scale 1-10
Dementia or non verbal- behaviour and collateral hx
Options for pain management
Txt the different points in pain pathway
1- pain detection- local anaesthetics or nerve block
2- pain transmission- opiates/ TCA/ gabapentin
3- pain expression- opiates/ sedatives and nitrous
4- pain modulation- massages/ splint/ TENS machine
4 side effects of NSAIDS
1- GI bleeding
2- ARF
3- Anaphlyaxis
4- TENS/ Stevens Johnson syndrome
5- PLT dysfunction
High risk- hypovol or dehydrate pt
Underlying renal or liver disease
On ACEi/ elderly/
Pregnant 3rd trimester
Ulcers GIT or hx GI bleed
What is MOA of local anaesthetics
Most effective in unmyelinated fibres
Reversible Na+ channel blockers
Effect the lipid membrane and effect depolarisation
Ionised form - don’t penetrate or work acidic environment like Abscess
Block A delta fibres
Sympathetic type B and C
Temp A delta
Touch A and B
List 2 classes of local anaesthetics
1) Esters - shorter t1/2 narrow Vd
Unstable in Sol and broken down by plasma cholinesterases
Procaine/ tetracaine benzocaine and cocaine
2) Amides
Lidocaine- max 3mg/kg no epi 40min duration
Prilocaine- 6mg/kg Beira block 3mg/kg
Rooivicaine- 0.2% 2mg/ml and 0.75% 7.5ml/kg max 2mg/kg
Bupivicaine- 2mg/kg
Metabolised by liver and kidney
What is toxic dose of lidocaine and bupivicaine
Lidocaine- toxic 3-5mg/kg and with adrenaline 7mg/kg
Bupivicaine- toxic 1.5mg/kg and 3mg/kg with adrenaline
Not used in kids
Or IV analgesia has high cardiotoxicity
What is toxicity of local anaesthetics
Local toxicity- local vasoconstriction
Systemic toxicity
Na channel blockade
Perioral tingling
Dysarythmias
Tinnitus
Dizzy
Agitation- nystagmus and headaches
Confusion- seizure
Coma
Cardiac- arrhythmia and arrest
What is treatment of local anaesthetic toxicity
1 supportive cares local Tox warm compress/ elevate arm
2- systemic
ABCD
ALS
Benzos- seizure midzolam 5mg IV
Intralipid emulsion
- bolus 1.5ml/kg over 1 min
- infusion 0.25ml/kg/min over 10mins
6 techniques to decrease pain of local anaesthetic injections
1 buffer with HCO3 1ml to 10ml lidocaine
2- warm
3- apply topical first EMLa
4- distract
5- inject edges
6
Topical anaesthetic agents
Intact skin- EMLA patch- procaine/ lignocaine 2ml on skin occlusive dressings about 60min onset
Angel gel- 4% amethocaine onset 20mins
Broken skin- viscous lignocaine
Lacerine- adrenaline/ lidocaine/ tetra Caine- 2ml wound occlusive dressing (4% lignocaine)
What is the dose of surcrose neonatal anaesthesia
Used 32 weeks to 4 months
Contraindicated <32 week or <1000g
24% solution sucrose give between 2-10ml
