Perioperative Analgesia Flashcards
What aspects of pain management should be discussed with the patient prior to surgery? (5)
- Patient’s pain history
- Preferences and expectations
- Likely impact of procedure on their pain
- Potential benefits and risks of treatments
- Discharge plan
A ___________ approach using _____________ to manage postoperative pain should be offered
multimodal
a combination of analgesics from different classes
Consider prescribing ____________ analgesia to ensure that the patient’s pain is managed when the effects of ______________ wears off
pre-emptive
local anaesthesia
Oral _____________ should be offered before and after surgery irrespective of pain severity, with intravenous _____________ reserved for patients unable to take oral medication
paracetamol
paracetamol
Oral paracetamol should be offered ________________ surgery irrespective of pain severity, with intravenous paracetamol reserved for patients unable to take oral medication
before and after
Offer oral ibuprofen to manage ___________ pain of all severities, except for patients who have had surgery for a hip fracture
immediate postoperative (pain during the first 24 hours after surgery)
Offer _______________ to manage immediate postoperative pain (pain during the first 24 hours after surgery) pain of all severities, except for patients who have had surgery for a hip fracture
oral ibuprofen
Intravenous NSAIDs should be reserved for patients __________________; if offering intravenous NSAIDs, choose a traditional NSAID rather than a COX-2 (cyclo-oxygenase-2) inhibitor
unable to take oral medication
Intravenous NSAIDs should be reserved for patients unable to take oral medication; if offering intravenous NSAIDs, choose ________________
A traditional NSAID rather than a COX-2 (cyclo-oxygenase-2) inhibitor
Intramuscular injections of diclofenac sodium and ketoprofen are _____________ (frequently/rarely) used in the management of perioperative pain; they are given deep into the gluteal muscle to minimise pain and tissue damage
Rarely
Suppositories of ______________ and ____________ may be effective alternatives to the parenteral use of these drugs in the management of perioperative pain.
diclofenac sodium
ketoprofen
Since non-steroidal anti-inflammatory drugs (NSAIDs) do not _____________, do not _____________, and do not _______________, they may be useful alternatives or adjuncts to opioids for the relief of postoperative pain.
depress respiration
impair gastro-intestinal motility
cause dependence
Opioid analgesics are now rarely used as ____________ in perioperative drug regimens; they are more likely to be administered at induction
premedicants; pre-operative use of opioid analgesics is generally limited to those patients who require control of existing pain.
Pre-operative use of opioid analgesics is generally limited to those patients who require _____________.
control of existing pain
An oral opioid should only be offered post-operatively if ____________________
immediate postoperative pain is expected to be moderate to severe
*should be given as soon as the patient can eat and drink after recovery
If using oral opioids for the management of post-operative pain, when should they be offered?
As soon as the patient can eat and drink after surgery
*patients unable to take oral opioids should be offered either a patient controlled analgesia or a continuous epidural
An oral opioid should only be offered if immediate postoperative pain is expected to be moderate to severe. Patients unable to take oral opioids should be offered either a(n) ______________ or _____________.
patient-controlled analgesia (PCA)
continuous epidural
The benefit of a continuous epidural should be taken into consideration for patients who are having ___________________, are expected to have _____________, or those who have ______________.
major or complex open-torso surgery
severe pain
cognitive impairment
____________ analgesics given in small doses before or with induction reduce the dose requirement of some drugs used during anaesthesia
Opioid
Which drugs may be used for intra-operative analgesia? (2)
- Opioids including alfentanil, fentanyl, remifentanil
2. Ketamine (unlicensed
Alfentanil, fentanyl, and remifentanil are particularly useful for providing intra-operative analgesia because they act within _____________ and have ___________ (long/short) durations of action
1–2 minutes
Short
____________, ____________, and _____________ are particularly useful for intra-operative analgesia because they act within 1–2 minutes and have short durations of action
Alfentanil
fentanyl
remifentanil
The initial doses of alfentanil or fentanyl are followed either by successive _______________ or by ________________; prolonged infusions increase the ______________ of effect.
intravenous injections
an intravenous infusion
duration
Repeated intra-operative doses of alfentanil or fentanyl should be given with care since the resulting _________________ can persist postoperatively and occasionally it may become apparent for the first time postoperatively when monitoring of the patient might be less intensive
respiratory depression
Alfentanil, fentanyl, and remifentanil can cause ________________, particularly of the ___________ or ____________; this can be managed by the use of neuromuscular blocking drugs
muscle rigidity
chest wall
jaw
Alfentanil, fentanyl, and remifentanil can cause muscle rigidity, particularly of the chest wall or jaw; this can be managed by the use of _________________
neuromuscular blocking drugs
In contrast to other opioids which are metabolised in the liver, ________________ undergoes rapid metabolism by nonspecific blood and tissue esterases; its short duration of action allows prolonged administration at high dosage, without accumulation, and with little risk of residual postoperative respiratory depression
remifentanil
In contrast to other opioids which are metabolised in the liver, remifentanil undergoes rapid metabolism by nonspecific blood and tissue esterases; its ___________ duration of action allows ____________ administration at high dosage, without ____________, and with little risk of residual postoperative _____________
Short
prolonged
accumulation
respiratory depression
Remifentanil should not be given by _______________ intraoperatively, but it is well suited to _______________; a supplementary analgesic is given before stopping the infusion of remifentanil.
intravenous injection
continuous infusion
A single dose of intravenous _____________ [unlicensed] should be considered either during or immediately after surgery to supplement other types of pain relief if, the patient’s pain is expected to be moderate to severe and an intravenous opioid alone does not provide adequate pain relief, or the patient has opioid sensitivity
ketamine
A single dose of intravenous ketamine [unlicensed] should be considered either _____________ or _____________ surgery to supplement other types of pain relief if, the patient’s pain is expected to be moderate to severe and an intravenous opioid alone does not provide adequate pain relief, or the patient has opioid sensitivity
during
immediately after
A single dose of intravenous ketamine [unlicensed] should be considered either during or immediately after surgery to supplement other types of pain relief if, the patient’s pain is expected to be _______________ and an intravenous opioid alone does not provide adequate pain relief, or the patient has ______________
moderate to severe
opioid sensitivity
