Pain medicine Flashcards
UFH (s/c prophylaxis) - NAB timings
- Wait following dose: 4 hours or normal APTT
- Wait following block: 1 hour
Indications for RF therapy
- Trigeminal neuralgia
- Cervical cordolay
- Cervicogenic headache
- Spinal pain
- Groin pain
- Orchidalgia
Define complex regional pain syndrome
A chronic pain disorder characterised by:
- vasomotor
- sudomotor
- trophic
- inflammatory.
What is CRPS Type 1?
Symptoms preceded by tissue injury.
What is the previous name for CRPS Type 1?
Reflex sympathetic dystrophy
What is CRPS Type 2?
Symptoms proceded by major nerve injury
What is the previous name for CRPS Type 2?
Causalgia
What is the pathophysiology of CRPS?
Unknown. Involves peripheral and central sensitisation and altered sympathetic function
What are the sensory symptoms of CRPS?
- Burning
- allodynia
- hyperalgesia
- sensory defects in CRPS 2
What are the autonomic symptoms of CRPS?
- Vasodilatation:
- Warm
- erythematous
- sweaty
- Vasoconstriction
- cold
- dry
- white
- Oedema also occurs
What are the trophic symptoms of CRPS?
- Atrophy of hair, skin and nails
- Joint stiffness
- Osteoporosis.
What are the treatment options for CRPS?
- Physiotherapy
- Pharmacological
- Interventional
- Surgical
- Psychological
- Alternative
What are the pharmacological treatments options for CRPS?
- Antineuropathic agents
- Opioids in refractory cases only
- Corticosteroids
- Calcitonin
- Bisphosphonates
- Free radical scavengers - NAC IV
- lidocaine infusions
What are the interventional treatment options for CRPS?
- LA sympathetic block i.e. stellate ganglion block
- Sympathectomies (RF ablation or surgically)
- Spinal cord stimulation
What are the surgical treatment options for CRPS?
- Surgical sympathectomy
- Amputation (reserved for most severe cases)
What are the physiotherapy treatment options for CRPS?
Graduated exercise programmes
What are the psychological treatment options for CRPS?
- CBT
- Pain management programmes
What are the alternative treatment options for CRPS?
Acupuncture
What is the budapest criteria?
A diagnostic criteria for CRPS
What are the 4 budapest criteria categories?
- Sensory
- Vasomotor
- Sudomotor/Oedema
- Motor/Trophic
What constitutes a diagnosis of CRPS on the Budapest Criteria?
- Symptoms in excess of the original insult
- At least 1 sign in 2 different Budapest categories
- At least 1 symptom in 3 difference Budapest categories
- No other better explanation for the symptoms
What are the sensory Budapest criteria?
- Allodynia
- Hyperalgesia
What are the vasomotor Budapest criteria?
- Temperature
- Asymmetry
- Skin colour changes
- Skin colour asymmetry
What are the Sudomotor Budapest criteria?
- Oedema
- Sweating changes
- Sweating asymmetry
What are the Motor/Trophic Budapest criteria?
- Reduced range of motion
- Motor dysfunction (weakness, tremor, dystonia)
- Trophic changes (hair loss, nail changes)
UFH (IV treatment) - NAB timings
- Wait following dose: 4 hours or normal APTT
- Wait following block: 4 hours
LMWH (s/c prophylaxis) - NAB timings
- Wait following dose: 12 hours
- Wait following block: 4 hours
LMWH (s/c treatment) - NAB timings
- Wait following dose: 24 hours
- Wait following block: 4 hours
Danaparoid prophylaxis - NAB timings
- Wait following dose: Avoid (consider anti-Xa levels)
- Wait following block: 6 hours
Danaparoid treatment - NAB timings
- Wait following dose: Avoid (consider anti-Xa levels)
- Wait following block: 6 hours
Bivalirudin - NAB timings
- Wait following dose: 10 h or normal APTTR
- Wait following block: 6 hours
Argatroban - NAB timings
- Wait following dose: 4 h or normal APTTR
- Wait following block: 6 hours
Fondaparinux prophylaxis - NAB timings
- Wait following dose: 26 - 42 hours (consider anti-Xa levels)
- Wait following block: 6 - 12 hours
Fondaparinux treatment - NAB timings
- Wait following dose: Avoid (consider anti-Xa levels)
- Wait following block: 12 hours