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Acute Care + Anaesthetics > Pain Management > Flashcards

Pain Management Flashcards

1
Q

How is pain classified?

A 
Duration:
- acute
- chronic
- acute on chronic
Cause:
- cancer
- non-cancer
Mechanism:
- nociceptive
- neuropathic
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2
Q

How is chronic pain defined?

A

Pain lasting > 3 months

Pain lasting after normal healing

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3
Q

What is nociceptive pain and how does it feel to the patient?

A

Obvious tissue injury or illness

–> sharp +/- dull, well localised

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4
Q

What is neuropathic pain and how does it feel to the patient?

A

Nervous system damage or abnormality

–> burning, shooting, numbness, pins + needles, poorly localised

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5
Q

Which non-drug treatments are available for pain management?

A

Physical:

  • rest, ice, compression, elevation
  • surgery
  • acupuncture, massage., physiotherapy

Psychological:
- explanation, reassurance, counselling

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6
Q

Which drugs are classed as simple analgesics?

A

Paracetamol (acetaminophen)

NSAIDs - diclofenac, ibuprofen etc

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7
Q

Which opioid is considered ‘mild’?

A

Codeine

Tramadol

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8
Q

Give some examples of strong opioids

A 
Morphine
Diamorphine
Oxycodone
Methadone
Fentanyl
Pethidine
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9
Q

Apart from simple analgesia and opioids, give some examples of other drugs used to manage pain:

A 
Tricyclic antidepressants --> e.g. amitriptyline
Anticonvulsants --> e.g. gabapentin
Ketamine
Local anaesthetics
Clonidine
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10
Q

How is pain assessed during routine nursing observations?

A

Pain score:
0 = no pain at rest or on movement
1 = no pain at rest, slight pain on movement
2 = intermittent pain at rest, moderate pain on movement
3 = continuous pain at rest, severe pain on movement

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11
Q

What is the treatment for mild pain (score 0-1)?

A

Paracetamol 1g 6 hourly

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12
Q

When should the standard dose of paracetamol be reduced?

A

If < 50kg

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13
Q

What is the treatment for moderate pain (score 1-2)?

A

Paracetamol (as before)
+ Codeine or Tramadol
+/- NSAIDs

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14
Q

What is the standard dose for codeine?

A

30-60mg 4 hourly

max 240mg/24hr

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15
Q

What is the standard dose for tramadol?

A

50-100mg 4 hourly

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16
Q

Which NSAIDs are good for post-op pain?

A

Diclofenac PO/PR

Ketorolac IV

17
Q

What is the treatment for severe pain (score 3 or predicted severe)?

A 
Continue paracetamol + NSAIDs (if tolerated)
Replace codeine/tramadol with either:
- oromorph
- PCA morphine
- short duration morphine
- regional technique e.g. epidural
18
Q

When should NSAIDs be used with caution?

A

Elderly
Dehydration
Asthma

19
Q

When are NSAIDs contraindicated?

A

Renal dysfunction
Coagulopathy
Peptic ulcer disease

20
Q

What is the process for giving oromorph to improve severe pain?

A

Give 10mg/5ml and wait one hour
Assess + document: pain, sedation, nausea + RR
If no improvement, repeat up to 2x unless sedation or RR < 10

21
Q

What is the criteria for administration of IV morphine?

A 
Adults only
Pain score 2 or 3
Systolic BP > 100
HR 60-100
RR > 8
Sedation score 0-1
Oxygen sats > 95%
Oxygen therapy started before drug given
Facilities to monitor patient 20 mins after dose
22
Q

When is IV morphine indicated?

A

Good for treating any severe pain –> titrated to effect

23
Q

What needs to be assess prior to initiating opiate titration?

A

Pain
Sedation
Nausea
Respiratory rate

24
Q

What should be done if a patient taking opiates is unresponsive/sedation score = 3?

A

Give oxygen 6 l/min
Discontinue opiates
Give naloxone
Contact pain team for advice on alternative analgesia

25
Q

What is the dose of naloxone used for opiate toxicity?

A

40mg increments titrated to effect + reassess patient

if you give a large bolus –> reverse all analgesia causing a lot of pain for patient

26
Q

What does PCA stand for?

A

Patient controlled analgesia

27
Q

What is the standard prescription for a PCA?

A

1mg of morphine, 5 minute lock out

28
Q

Who prescribes/organises PCA?

A

Acute pain team

29
Q

When should a PCA be stopped?

A

When the patient is able to tolerate oral analgesia

30
Q

How do epidurals work for pos-op pain management?

A

Sited by anaesthetist in theatre and left in for a few days

- infusion of local anaesthetic + opioid e.g. fentanyl

31
Q

Which blood test must be checked before insertion of an epidural and why?

A

Coagulation –> must be normal before insertion and removal to prevent epidural haematoma
(do not given LMWH within 12 hours)

Acute Care + Anaesthetics (9 decks)

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