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Y3 OMS > Post-operative Pain Control > Flashcards

Post-operative Pain Control Flashcards

1
Q

What causes post-op pain?

A

Inflammation
- reaction of vascularised living tissue to local injury
- injury may be caused by microbial infection, physical agents, chemicals, necrotic tissue
- contain and isolate injury, destroy invading micro-organisms and inactivate toxins

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2
Q

What are the signs of acute inflammation?

A

Heat, redness, edema, pain and loss of function

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3
Q

Describe the surgical/clinical factors causing post-op pain

A

1) difficulty of procedure
- deep impaction, bulbous roots, texture of bone, amount of bone removal required, size of flap raised

2) presence of inflammation or infection present at time of procedure

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4
Q

Describe the operator factors causing post-op pain

A
  • Experience and competence
  • Duration of operation
  • Handling of tissue
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5
Q

Describe patient factors that cause post-op pain

A
  • Subjective
  • Depends on past experiences, emotional, cultural and social factors
  • Compliance with post-op instructions, medication intake
  • Individual response to analgesics (pharmacokinetics)
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6
Q

How to achieve pain relief?

A
  • Patient factors
  • Surgical factors (good LA)
  • Medications
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7
Q

How to achieve effective pain relief with LA?

A
  • good technique
  • articaine (concentration of LA)
  • Long acting LA on completion (bupivacaine)
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8
Q

Name the 3 types of medications for pain relief

A
  • Simple analgesics
  • NSAIDs (non-selective COX inhibitors and selective COX-2 inhibitors)
  • Narcotics
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9
Q

Describe acetaminophen

A

Aka tylenol/ paracetemol

  • mild to moderate pain
  • effective anti-pyretic agent
  • weak prostaglandins inhibitor
  • no anti-inflammatory effect
  • metabolised by liver
  • symptoms include dizziness, excitement, disorientation (large doses)
  • 15g toxic amount (fatal due to hepatic toxicity symptoms - diarrhoea, vomiting, abdominal pain)
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10
Q

List NSAIDs (non-selective and selective COX-2 inhibitors)

A

Non-selective: (common)
- ketorolac
- mefenamic acid
- ibuprofen
- naproxen

  • Indomethacin -> joint pain (less common)
  • Diclofenac
  • aspirin (used more for anti-platelet effect than analgesic)

Selective:
- Celecoxib (common)
- Etoricoxib

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11
Q

Describe the action and effects of NSAIDs

A
  • inhibit synthesis of prostaglandins in the endo peroxide pathway
  • side effects: dyspepsia (indigestion), gastric mucosal damage, increased bleeding

*prostaglandins helps to maintain renal blood flow, gastric mucin production, mucosa protection and maintenance of platelet function BUT causes pain, inflammation, fever

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12
Q

Describe the characteristics of Aspirin

A
  • analgesic
  • anti-inflammatory
  • antipyretic
  • anti-thrombosis
  • mild to moderate pain
  • non selective COX inhibitor -> COX-1 inhibition undesirable (not used for post-op analgesic)
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13
Q

Describe the characteristics of ibuprofen

A
  • Analgesic
  • Anti-inflammatory
  • Anti-pyretic
  • Non selective COX inhibitor (peripheral prostaglandin inhibition)
  • Mild to moderate pain
  • 400mg every 4-6 hourly
  • may combine with narcotics drug for severe pain
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14
Q

Describe the characteristics of naproxen

A
  • Analgesic
  • Anti-pyretic
  • Non-selective COX inhibitor
  • Mild to moderate pain
  • Propionic derivatives
  • Extended half life (10-20h)
  • Dosage 550mg twice daily
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15
Q

Describe the characteristics of ketorolac

A
  • Analgesic
  • Antipyretic
  • Pain control comparable to morphine but without side effects
  • Parental dose: 30mg IV, 60mg IM (healthy patients 50kg and above)
  • Repeat dose every 6h, max dose should NOT exceed 120mg
  • Follow up with oral dose 20mg, then 10mg 4-6h after, max dose 40mg
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16
Q

Describe the characteristics of Etoricoxib

A
  • COX-2 inhibitor
  • Take every 24h
  • Avoid pregnancy, nursing
  • Avoid those in risk of thrombotic events
  • Avoid in patients taking ACE inhibitors (cause high BP)
  • Can result in high BP, fluid retention, peripheral edema
17
Q

Describe the characteristics of Celecoxib

A
  • COX-2 inhibitor
  • 200mg twice daily,
  • Same precautions as etorizoxib- avoid use of those with known sulfonamide allergy
  • increases risk of heart attack and stroke
18
Q

Describe the characteristics of narcotics

A
  • Act on opioid receptors, mu, kappa and delta
  • activation of opioid receptors - inhibition of pain transmission
  • Opiod mu receptors activated by codeine, hydrocodone, tramadol and morphine
  • Drugs and neurotransmitters that act on receptors and may cause biological effects
  • mu receptors have analgesic effects and respiratory depression
19
Q

Describe the characteristics of Tramadol

A
  • type of opioid
  • central acting analgesia
  • used in patients with NSAID allergy
  • low levels of dependence
  • side effects: headache, nausea, sweating, drowsiness
  • 400mg/day MAX dose
20
Q

What are the side effects of opioids?

A
  • Sedation
  • Nausea
  • Vomiting
  • Constipation
  • Mood alteration
  • Respiratory depression
21
Q

List 3 commonly used oral narcotic analgesics (dosage and frequency)

A

1) codeine (30-60mg twice daily) -> max 360mg daily

2) tramadol (50-100mg twice daily) -> 400mg daily

3) Panadeine (2 tab twice daily) -> do not give when patient allergic to paracetemol

22
Q

Which is most effective? NSAIDs, paracetemol, or opioids in reducing post-op pain?

A

Combination!!!

No clear difference between NSAIDS and paracetemol

23
Q

What are the patient factors determining the choice of analgesic?

A

1) MH
- G6PD/asthma/renal failure
- renal failure: use paracetamol, DO NOT use NSAIDs when NOT on dialysis, NSAIDs safe to use when on dialysis

2) Drug allergy
3) Pregnancy
- DO NOT use aspirin (causes vascular disruption)
- NSAIDs used in late trimester can increase risk of premature diurnal closure
- DO NOT use opioids
- Opiods in late pregnancy with long term use may cause neonatal withdrawal syndrome

4) Nursing mother
- use paracetemol
- NSAIDs mostly safe
- DO NOT use opiods

24
Q

Which steroid can be used to control pain?

A

Dexamethasone reduces pain and swelling after extraction of wisdom teeth

Y3 OMS (14 decks)

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