Post-op pain management Flashcards
General anesthesia
a reversable state of unconsciousness produced by drugs with sufficient depression of reflexes to allow surgical procedure to be performed
Goals of general anesthesia
- unconsciousness
- analgesia
- muscle relaxation
- depression of autonomic endocrine reflexes
(want to reduce the risk of this pain becoming chronic pain)
Phases of medication administeration
- preoperative
GOAL: prepare pt for surgery - optimize medical status, decrease surgical complications
Antianxiety, PPIs, pre-emptive analgesia, depress reflex activity - Introp
- induction (pt awake to unconscious) - propofol, midazolam
- maintenance of induction
GOAL: unconscious, muscle relax, analgesia - reversal
GOAL: return pr to conscious state with breathing while maintaining analgesia - recovery
GOAL: airway maintenance and ventalation, cardio stability, normothermia, consciousness, freedom from N+V, analgesia
LOTTAARP
Location
Onset
Timing
Type
Associated symptoms
Alleviating factors
Radiation
Precipitating event
Regional Anesthesia (neuraxial blocks)
Spinal and epidural
Spinal Anesthesia location
Injection of local anesthetic/opioids into the CSF of the subarachnoid space (between arachnoid and pia mater)
below L2
nerves are in CSF
spinal anes insertion
spinal cord ends at L1L2, a fine gauge needle is inserted at L2L3 or lower to avoid spinal cord
A single done of opioid and local anesthetic is injected causing an autonomic, sensory and motor blockade (can cause rapid toxicity)
What is the pts experience of spinal anes?
vasodilation/hypotension (autonomic block)
no pain (sensory block)
unable to move (motor block)
What to monitor for spinal anes
VS
motor and sensory block
urinary output/bladder distention
headache assessment
Epidural anesthesia location
a catheter is placed in the epidural space located outside the 3 membranes covering the spinal cord between the dura mater and the ligamentum flavum - filled with BV, lymphatic vessels, spinal nerve roots
binds to the nerve roots as they enter and exit the spinal cord (local anes.)
allows for better titration and control of the extent of sensory and motor blockade
may be sole anesthetic for surgery or a catheter may be placed to allow intra and post op analgesia using lower doses of epidural local anes. and opioid
catheter may be in thoracic (less complications) or spine
Epidural anes monitoring
urinary output/bladder distention
assess for pruritis, N/V
Pain assessment
assessment for catheter migration (numbness, tingling)
assess pf drsg and insertion site
headache assessment
Function decline order
Sympathetic (vasomotor): dilation of skin and blood vessels
Temperature discrimination
pain recognition
Touch and pressure sense
motor function
as the anesthetic wears off, the above nerve function will return in reverse order will have motor function, but still pain management
Chronic Postoperative Pain (CPOP) risk factors
preop pain
psychological factor
female and younger age
open surgical approach
length of surgery is over 3 hours
intensity of pain in immediate post op period
What are the harmful effects of under treated acute pain
Cardio: tachycardia, increased heart O2 consumption, DVT, MI
Resp: decreased lung volumes, atelectasis, decreased cough, sputum retention, hypoxemia
GI/GU: decreased gastric and bowel motility, urinary retention
Metabolic: increased metabolic hormones (cortisol), decreased anabolic hormones (insulin)
Psychological: anxiety, dear, sleeplessness
Do you have to worry about stopping infusions with epidurals?
no, air bubbles are not a danger and it is ok to stop infusions for hours and restart without worry about catheter occluding
