Peri-operative Pain Management

Question 1

Hypnotic agents for analgesia

Answer 1

N2O

Ketamine

Question 2

Secondary analgesics

Answer 2

Tricyclic antidepressants
SSRIs
Anti-convulsants
Gapapentin
Steroids
Clomidine, Dexmeditomidine (A2 agonists)

Question 3

Widely used OTC analgesic and antipyretic

IV, tablet, liquid suspension, suppository, IV (Perfalgan)

Answer 3

Paracetamol

Question 4

Myprodol components

Answer 4

Codeine + Paracetamol + Ibuprofen

Question 5

Adult dose of paracetamol

Answer 5

1g 6 hourly p.o.

Question 6

Analgesic classes

Answer 6

Simple analgesics
NSAIDS
Opiates
Local anaesthetics
Hypnotic agents
Secondary analgesics (chronic pain)

Question 7

Max daily dose of paracetamol

Answer 7

4g (children 19mg/kg/day)

Question 8

OVERDOSE of Paracetamol causes fatal _______ damage

Answer 8

Liver

Question 9

Mechanism of action of NSAIDS

Answer 9

Inhibition of cyclo-oxygenase –>

COX catalyzes prostaglandin, thromboxane and arachidonic acid production

Question 10

Selective cox inhibitor

Answer 10

COX 2

Question 11

Non-selective cox inhibitor

Answer 11

COX 1

Question 12

COX 2 inhibitor examples

Answer 12

Celecoxib

Parecoxib

Question 13

Adverse effects of NSAIDS

Answer 13

GI ulcers
Platelet dysfunction --> bleeding
Nephropathy
Bronchospasm *aspirin
Hepatotoxicity

Question 15

Cox1

Answer 15

Diclofenac
Ibuprofen
Indocin

Question 16

Opiate Antagonist

Answer 16

Naloxone

Question 17

IV cox1 inhibitor

Answer 17

??

Question 18

Common OPIATE side effects

Answer 18

PONV
Constipation
Itchiness/Pruritis
Urinary retention

Question 21

Short-acting synthetic opioid
3 minute onset
40 minute DOA

Answer 21

Fentanyl

Question 22

COX-2 risk

Answer 22

Acute myocardial infarction

CVA

Question 23

IV cox 2 inhibitor

Answer 23

parecoxib

Question 24

Dangerous Opiate side effects

Answer 24

Respiratory Depression
Reduced LOC
Allergy
Muscle Rigidity

Question 25

Panadiene components

Answer 25

Paracetamol plus Codeine

Question 26

Codeine uses

Answer 26

Cough suppresants

Diarrhoea management/Promote constipation

Question 27

Codeine dosage

Answer 27

8mg or 30mg

Question 28

Potent hypnotic agent which works on NMDA receptor used in sub-anaesthetic doses for analgesia

Answer 28

KETAMINE

Question 29

Morphine dose intra-op

Answer 29

Intra op 0.1mg/kg | 10mg amps Adult 5-7mg morphine

Question 30

Post-op morphine dose

Answer 30

10mg IM 4 hourly

Question 31

Naloxone dosage

Answer 31

1-4 ug/kg Dilute 0.4 mg in 1 ml ampoule into 10ml and give 2 ml at a time

Question 32

Naloxone side effects

Answer 32

Antalgesia Hypertension Dysrhythmia Pulmonary oedema

Question 33

Indications of pain under GA

Answer 33

Sweating increased HR and BP Lacrimation Movement

Question 34

Intra-op analgesia options

Answer 34

``` Opiates Paracetamol IV or rectal NSAIDI IV or rectal La infiltration of wound Neuraxial blockade Periph nerve blockade ```

Question 35

Goals of Post-op analgesia

Answer 35

Prevent LRTI: Breathe well/cough Analgesia Decreased stress response Early mobilization (min DVT and muscle wasting)

Question 36

Post-op analgesia options

Answer 36

IM morphine or PCA (in combo with Ketamine And .......... ) Paracetamol Iv/po Codeine combos NSAIDS neuraxial blockade: Epidural infusion in ICU (Periph nerve blockade, spinal, LA wound inflitration)

Question 37

Anti-emetic prescribed with Morphine

Answer 37

Stemetil 12.5mg IM 6 hourly

Question 38

Risk of using Diclofenac IM

Answer 38

NECROSIS

Question 39

Short acting opiates

Answer 39

Fentanyl Remifentanil (ultra-short) Sufentanil (short!) Alfentanil

Question 41

NSAID examples

Answer 41

Ibuprofen Voltaren (Diclofenac) Indomethacin (Indocid) Cox 2 inhibitors

Question 67

Opiates

Answer 67

``` Fentanyl Sufentanyl Alfentanil Remifentanil (infusion, instantaneous) Morphine Codeine Tramadol pethidine Tramadol ```