Peri-op Analgesia Flashcards
What is equivalent dose of morphine from fentanyl?
Fentanyl 100 times more potent
Therefore 1mg morphine = 10mcg fentanyl
Presentation of fentanyl?
Synthetic opioid 2 and 10ml ampules 50mcg/ml Lipid soluble Ionised at neutral pH therefore water soluble
Pharmacokinetics of fentanyl?
Short acting
Initial bolus 1-3mcg/kg
E- Analgesia lasts 15-30 mins for 50-100mcg bolus
A- Distributed in vessel rich tissues
D - Can accumulate in fat
M- Metabolism in liver to inactive products
What are common effects of fentanyl?
Analgesia Bradycardia Hypotension Respiratory depression (increased depth of breathing then shallow) Opioid side effects!
Pharmacodynamics of morphine?
Slow onset analgesic
2-5mg bolus
Lasts for 30-40 mins
Pharmacokinetics of morphine?
Less lipid soluble
Longer lasting
Distributed in vessel rich tissue
Liver metabolism - morphine-6-glucuronide more potent
Be careful in renal failure! Can accumulate.
Presentation of morphine?
Naturally occurring from opium poppy
1ml ampules - 10mg/ml to be diluted in 9ml of saline = 1mg/ml
Less soluble
What analgesia requirement for k wire removal in healthy adult?
Fentanyl at induction for removal (stimulus)
No further requirement as should be pain free and also needs home
Describe ibuprofen?
Presentation
- tablets 200mg, oral suspension 100mg/5ml
PD - inhibit cox 1 +2 enzyme non selectively, Pg release inhibited reducing inflammation and providing analgesia
SE - gastric irritation and inhibits platelet aggregation
CI - GI ulcers, asthmatics, renal impairment
Describe diclofenac?
Presentation
- tablets 25mg or 50mg , sup 50mg and 100mg
IV 25mg/ml 3ml ampules max daily dose 150mg/24h
PD - 8x more potent than ibuprofen, inhibit cox 1 +2 enzyme non selectively, Pg release inhibited reducing inflammation and providing analgesia
SE - gastric irritation and inhibits platelet aggregation
CI - GI ulcers, asthmatics, renal impairment, porphyria
PCA pump set up?
1-2mg/ml boluses
5 min lockout
