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Anaesthesia > Pain management > Flashcards

Pain management Flashcards

1
Q

What is pain?

A

A sensory experience that is associated with tissue damage

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2
Q

Why do we want to avoid pain?

A 
stress to patient 
Prolonged recovery 
Poor/delayed wound healing 
impairs respiratory and cardiovascular function 
Reduced food intake 
Self trauma 
Reduced mobility 
Is our ethical responsibility
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3
Q

How does the body respond to intra-operative pain?

A

Increased HR and RR
Dilation of bronchi
Adrenaline release leads to cardiac arrhythmias
Dilation of blood vessels in skeletal muscle
Constriction of BVs in GI tract

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4
Q

How does the body respond to acute pain?

A

ASsociated with injury/trauma
Usually abates as healing occurs
Does not usualy outlast the initaial painful stimulus

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5
Q

How does the body respond to chronic pain?

A

Pain that outlasts the initial painful stimulus
Can be defined as pain lasting longer than anticipated
British pain society defines as ‘pain lasting longer than 12 weeks’
Significane: chronic pain can lead to changes ein the pain pathways of the central and peripheral nervous system

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6
Q

What is analgesia?

A

loss of sensitivity to pain/absence of pain

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7
Q

What is hypoalgesics?

A

More accurate term, due to absolute analgesia being achieved by local anaesthetics - pain transmission completely blocked

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8
Q

What is pre-emptive analgesia?

A

admin of analgesics prior to pain stimulation preventing neuron sensitization

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9
Q

Describe the physiology of pain

A

Painful (noxious) stimulus associated with tissue damage and release of inflammatory mediators leading to activation of pain receptors in pain fibres (nociceptors)
Nociceptors transmit pain signals to the CNS via pain pathways
Repeated stimulus of pain pathways can lead to heightened sensitivity

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10
Q

Describe the pain pathway

A

Pain is detected by nociceptors that then convert the painful stimulus into a nervous signal (transduction)
The impulse is transmitted via pain fibres into the dorsal horn of the spinal cord
The signal is modulated in the CNA
Information is sent to the brain where perception of pain occurs

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11
Q

What are the types of pain?

A

Physiological
Inflammatory
Neuropathic

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12
Q

Describe physiological pain

A

Pain that goes when stimulus removed, protective pain

Response is proportionate to stimulus e.g. thorn in paw

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13
Q

Describe inflammatory pain

A

Clinical pain e.g. caused by surgery

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14
Q

Describe Neuropathic pain

A

Caused by direct damage to nervous system e.g. phantom limb

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15
Q

Describe ongoing pain

A

Continuing or severe pain can cause sensitisation of both peripheral and central pain pathways and can eventually change the way an animal responds to a stimulus. This can lead to a chronic hypersensitivity to pain that can outlast the actual painful event.

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16
Q

What is allodynia?

A

sensitive to stimuli that would not normally cause pain

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17
Q

What is hyperalgesia?

A

Greater insentity and duration of pain than expected

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18
Q

What is pre-emptive anallgeisa and what is it used for?

A

The admin of analgesic prior to tissue trauma

Used to: Prevent pain pathway, easier pain management post-op

19
Q

Give examples of analgesic drugs

A 
Opiods
NSAIDSs
Alpha 2 adrenoceptor agonists
Local anaesthetics
Ketamine 
Gabapentin
20
Q

where do opioids act upon?

A

centrally and peripherally

21
Q

what are the types of agonists?

A

Full and partial

22
Q

Give an example of a full opioid agonist and what are they used for?

A

morphine, fentanyl, methadone, pethidine and butorphanol

Used for moderate-severe pain, can be topped up, increased dose increases analgesia

23
Q

Give an example of a partial opioid agonist

A

buprenorphine

Used for mild-moderate pain

24
Q

What are the most commonly used opiods?

A

Methadone and buprenorphine

25
Q

How do NSAIDs work?

A

they inhibit the production of inflammatory mediators i.e. prostaglandins via the inhibition of COX enzymes
Some drugs are COX 2 selective as COX 1 is considered to have a protective effect on the gut lining and kidneys.
NSAIDs work at the transduction stage of the pain pathway

26
Q

What do you use NSAIDs for?

A

peri-operative pain relief

Management of chronic pain

27
Q

Give examples of NSAIDs

A 
meloxicam 
Aspirin 
Carprofen 
Robenacoxib 
Ketoprofen 
Paracetamol 
Phenybutazone
28
Q

What are some side effects of NSAIDs?

A

Renal - prostaglandins play a role in maintain GFR and renal blood flow in the face of low BP. Therefore inhibition of PGs may lead to renal dysfunction or failure.
GIT - cox 1 enzymes are responsible for mucous secreting and maintain blood flow to the gut. Therefore NSAIDs may cause gastric ulceration.

29
Q

When should you avoid the use of NSAIDs

A 
dehydrated 
hypotensive 
pre existing renal disease
liver disease
animals already on corticosteroids or other NSAIDs
30
Q

What are local anaesthetics considered to provide?

A

total analgesia as they block the conduction of nociceptive impulses

31
Q

Give examples of local anaesthetics

A 
lignocaine
Bupvicaine
Mepivicaine
Alpah 2 adrenoceptor agonsits - at lowr doses
Ketamine
32
Q

What is gabapentin used to treat?

A

neuropathic pain in adult animals

33
Q

What is acupuncture used for?

A

used to complement pharmaceutical measures in painful patients
More often in chronic pain
Variable response between induvial patients

34
Q

What is multimodal analgesia?

A

Multimodal analgesia is the use of multiple drugs. Incorporating different pharmacological actions to produce optimal analgesia

35
Q

What are some examples of drugs used in multimodal analgesia?

A

NSAIDs with opioids, alpha-2 agonists and local anaesthtitic techniques

36
Q

Describe ‘milk infusions’

A

This is a method that is increasing in use in canine patients. Includes:
-500ml of either NaCl or Hartmann’s
-10mg morphine
-150mg lidocaine
-30mg ketamine
This is given by infusion and avoided in cats due to sensitivity to lidocaine

37
Q

What does pain behaviour vary depending on?

A

Species, breed, age, sex and temperament

38
Q

What are signs of pain in cats/dogs?

A 
Chewing/licking wound
Aggression or change of temperament 
Vocalisation 
Cowering at back of cage
Anorexia
Panting 
Hunched
Prayer stance 
Altered facial expression 
Limping
39
Q

What are the signs of pain in small mammals?

A 
'prey' species will attempt to mask pain 
Anoerxia 
Teeth grinding 
Reluctant to move 
Limping 
Squinting 
Hunched up 
Dull
Aggression 
Chewing of wound 
Vocalisation if severe
40
Q

Why do we need to recognise pain?

A

To maintain animal welfare by both recognising pain and being prepared to act upon these findings

41
Q

What are examples of pain scoring systems?

A 
Simple descriptive scale
Numerical rating scale
Visual analogue scale 
Glasgow composite pain scale 
Colorado state pain scale for cats
42
Q

What happens if a patient has a painful/stormy recovery?

A

Palpation of wound should elict painful or heightened response
Painful animals may be temprerily distracted unlike these who are dysphoric
Notify the VS, if concerns, may require further anagleisa/sedation

43
Q

What is the vital role od VN?

A

Monitor, record and report signs of pain behaviour
Vital role in pain management and assessment
VN is main care for hospitalised patients

44
Q

What jobs are involved as a VN?

A

Admin of appropriate analgesic drugs
Good nursing care
Clean warm bedding
Use and care of bandages
Comfortable environment
Allow toileting and eating as close to normal as possible
Psychological support (talking, stroking and reassuring patient)

Anaesthesia (16 decks)

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