Peri-operative Pain and PONV

Question 1

know 3 different pain killers!

Know 3 different antiemetic

know them MOA, indication, side effects, dose etc

What are three very important factors post surgical- (PAIN, Nausea, vommitting and pain)

Answer 1

Question 2

Need to ask the following in each setting:

Pain is a warning sign! both pre and post operatively,

How do we take a pain hx?

Answer 2

Question 3

Start with

1. Vitals signs !!!!!!
2. Examination - pre-op and post-op- (look for bleeding, pain, signs of infection, abdomen tender/distended)

Answer 3

Question 4

How do we evaluate pain once we have examined patient??? (need to know)

Answer 4

Question 5

What is the WHOP ladder of analgesia

Answer 5

Question 6

Analgesia WHO ladder step 2:

Answer 6

Question 7

Opiates: Need to explain side effects

Answer 7

Side effects:

1) Sedation
2) respiratory depression
3) itchiness
4) Nausea and vommitting
5) Allergy
6) Rashes/Serotonin syndrome

Question 8

Fentanyl: Quickest acting

• Can give small bolus doses - 0.24-0.5
• can be given Nasal, SC
• Could need 1-2mcg/kg - therefor 80kg male - 80-160 microgram - thus start low
• Bolus dose 1–25-50mcg
• Fast onset but wearing off by 30

Answer 8

KNOW

Question 9

Morphine:

MOA:

Routes:

IM/SC - up to .1/.2mg/kg- depending on factors - obesity etc

Duration -3-4 hours max

Side effects as for other opiates- much longer

CKD (reduce dose and interval)

Answer 9

Question 10

Oxycodone: IR - for acute pain

Better orally then morphine - can generally use same dose as IV and oral

Answer 10

++++++ abuse potential!

IV dose

Question 11

Tramadol / Tapentadol IR:

Answer 11

Both have different MOA

Question 12

Pain and pain killer can make patients feel nauseated:

Answer 12

Question 13

Who is at high risk for PONV (apfel score)

–> inner ear operations

Answer 13

Question 14

First line antiemtics for children:

Know Side effects: headaches, diarrhoea, constipation, agitation, tachycardia

Question 15

Metoclopramide:

MOA: 10-20mg IV hourly

Dose:

Route:

SE: Dyskinesia, extrapyramidal side effects/oculogyric crisis, lockjaw or episthotonus

GIVE benzotropine for severe side effect

Answer 15

Question 16

Antihistamines:

Least to most sedative

Answer 16

Question 17

Other anti emetics:

Steroids - MOA - SE - hyperglcaemia (need to watch)

Droperidol -

Question 18

Case 1:

Give paracetomol

Give opiate- Morphine - long half-life

Answer 18

Second line - Odansetron 4mg wafer

Question 19

Case 2:

Answer 19