Pain Management Post Op Flashcards
Adjuvants?
Drugs used in conjunction with opioids and non opioids
- remove side effects of analgesics
- properties assist and relieve pain
Sometimes referred to as coanalgesic
Adjuvants are used at every step in the WHO ladder
Breakthrough pain?
Pain that occurs despite treatment
PCA?
Patient controlled analgesia
Method of pain control designed to allow the patient to administer pre set dosages of an analgesic I
Nociceptive pain?
Pain caused by damage to somatic or visceral tissue
Neuropathic pain?
Pain caused by damage to nerve cells of changes in spinal cord processing
Pain threshold vs tolerance?
Threshold: the point beyond which a stimulus causes pain
Tolerance: max level of pain a person is able to tolerate
What’s is a sedation scale?
A number to assess level of sedation of a patient
The higher the number the more sedated they are
0-4
-RASS
(Richmond agitation sedation scale)
True of false
Nociceptive pain occurs when there is damage to somatic and/or visceral tissue?
True
Neuropathic pain vs Nociceptive pain?
Neuropathic:
- burning, shooting, electric pain
- difficult to treat
- involves nerves
Nociceptive:
- aching/throbbing pain
- responsive to opioids and non opioids
- involves tissue
Why is the WHO ladder a little different for surgical patients?
You start high and titrate down
(3) strong opioid
(2) weak opioid
(1) non opioid
Examples of adjuvants?
Corticosteroids
Antidepressants
Muscle relaxant
Anti inflammatory
What is pain?
Multidimensional
Objective and subjective
Pain is what the person says it is
Complex
Pain assessments?
PQRST
Faces, 0-10
Non verbal body language
What effects a persons pain goal?
Individualized based on patient needs
Different pain tolerance/threshold
Gender, age
Cultural considerations
2 types of Nociceptive pain?
Somatic: skin, mucosa, muscles, joints, bone
-sharp, constant, throbbing, gnawing, aching
Visceral: organ, GI tract
-dull, cramping, squeezing, deep, aching
Multimodal pain management?
The use of more than than 1 form of analgesia at the same time that is satisfactory to the patient
Can Nociceptive and neuropathic pain be chronic?
Both types can become chronic
Typically surgical patient pain is more acute
Physiological effects of untreated pain?
Increase in vitals Changes in cognition Decrease sleep or bed seeking Decrease appetite Delayed healing Diaphoretic Nausea Photosensitivity Increase risk of infection GI and GU changes
Consequences of untreated pain?
Decrease patient satisfaction Decrease compliance Increased recovery time Hospital readmissions Decreased QOL
Factor contributing to poor pain management?
Inadequate assessments Failure to consider available pain therapies Attitudes/beliefs Poor pt compliance Fear of addiction Misconceptions Lack of education
How is post op pain different?
Pain is d/t tissue and nerve endings being traumatized
Pain is normally localized to the incision because it’s the primary location of trauma
Perception of post op pain is individualized
Post op pain assessment?
PQRST
Pain assessment at rest and movement
Break through pain ex. During dressing changes
Non pharmacological pain management tools commonly used in surgical units?
Explanation and reassurance Warm blankets Ice Limb elevation Ensuring drains are not pulling
Pharmacological postoperative pain management?
WHO analgesic ladder
Around the clock dosing
Mixed analgesic drugs
-holistic pain management
Common analgesic routes?
Oral: peaks 30-60min SR opioids last 8-12hrs IR opioids lasts 3-4hrs IM: peaks 10-30min Subcu: peaks 10-20min IV: rapid onset, only lasts 1-4hrs Epidural: onset 6-30min Spinal PCA
Examples of analgesics used on the WHO ladder?
Strong opioids: hydromorphone, morphine, fentanyl
Weak opioids: Tylenol 3, codeine
Non opioids: Advil, ibuprofen
Analgesic gaps?
Specific time periods when the management of post op pain is often inadequate
- transfer between services/hospital location
- transition from IV/PCA/epidural to oral or alternative therapy
- periods when breakthrough pain is experienced
Considerations of pain management for older adults: physiological changes?
Increase disease process Loss of muscle and fat Decrease in cognitive reserves Level of independence is decreasing Dementia? Multi-morbidities? May not be able to verbalized their pain
Pharmacological considerations in the older adult?
Acetaminophen is very effective
NSAIDS cause morbidity and mortality
Neuropathic adjuvants are not well tolerated
Midazolam is the only benzo tolerated because the rest causes neuroexcitation
How delirium different from dementia?
Sudden/acute onset
Medical emergencies
Fatal
Reversible/treatable
Causes of delirium?
Levels of dementia Reaction to anaesthetic Reaction to meds Acute/untreated pain Electrolyte imbalances Blood/fluid loss Potential infection Alcohol withdrawal Constipation
What to do if someone is delirious?
Comprehensive assessment
Explore hx to determine baseline orientation
Treat for pain
Consider changing the dose of type of opioid
Reassure family and seek their help
What are some basic principles of pain treatment?
Routine assessments
Untreated pain complicates recovery
Patients self report should be used whenever possible
Involve patient and family
Always accept patients pain reports and document them
