Pain + Nausea

Question 1

Consequences of Poor Pain Control

Answer 1

Reluctant to mobilise - slower restoration of function and rehabilitation

Will not breathe as deeply -inadequate ventilation and subsequent atelectasis and hospital-acquired pneumonia

Question 2

Patient Controlled Analgesia

Answer 2

Intravenous pumps that provide a bolus dose of an analgesic when the patient presses a button

Question 3

Which patient group should NSAIDs be avoided in?

Answer 3

Asthmatics

Question 4

Prophylactic measures to reduce nausea and vomiting

Answer 4

Reduce opiates, reduce volatile gases, avoiding spinal anaesthetics

Prophylactic antiemetic therapy

Dexamethasone - at induction of anaesthesia

Question 5

Conservative Measures to reduce nausea and vomiting

Answer 5

Adequate fluid hydration

Adequate analgesia

Nasogastric tube insertion to aid gastric decompression

Question 6

Impaired gastric emptying mx

Answer 6

metoclopramide or domperidone - dopamine antagonist

Unless bowel obstruction suspected

Question 7

Reduce secretions

Answer 7

Hyoscine (anti-muscarinic)

Question 8

Opioid-induced N&V mx

Answer 8

ondansetron (5-HT3 receptor antagonist) or cyclizine (H1 Histamine receptor antagonist)

Question 9

Patient factors for post op N+V

Answer 9

Female gender
Young 
Previous PONV or motion sickness
Use of opioid analgesia
Non-smoker

Question 10

Surgical factors for post op N+V

Answer 10

Intra-abdominal laparoscopic surgery

Intracranial or middle ear surgery

Gynaecological surgery, especially ovarian

Prolonged operative times

Poor pain control post-operatively

Question 11

Anaesthetic Factors for post op N+V

Answer 11

Opiate analgesia or spinal anaesthesia

Inhalational agents (e.g. Isoflurane, nitrous oxide

Prolonged anaesthetic time

Intraoperative dehydration or bleeding

Overuse of bag and mask ventilation (leading to gastric dilatation)

Question 12

Which antiemetic is not used in HF

Answer 12

Cyclizine as can cause fluid retention