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Peri-Operative Care [16] > Post-Operative Pain Management > Flashcards

Post-Operative Pain Management Flashcards

1
Q

What can pain be divided into?

A

Acute and chronic types

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2
Q

In what respects can post-operative pain be assessed?

A

Subjectively and objectively

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3
Q

How is post-operative pain assessed subjectively?

A

By asking the patient to grade their pain on a scale of mild, moderate, or severe

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4
Q

What can subjective post-operative pain be assessed as part of?

A

Regular nursing observations

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5
Q

Why is asking the patient to grade their pain on a scale from 1 to 10 problematic?

A

Because it requires the patient to quantify their pain into a number, and then the doctor is then required to interpret that into an appropriate analgesia regime

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6
Q

How is pain assessed objectively?

A

By looking at the clinical features of pain

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7
Q

What are the clinical features of pain?

A
  • Tachycardia
  • Tachypnoea
  • Hypertension
  • Sweating
  • Flushing
  • Unwillingness to mobilise or agitation in those that are less able to communicate their pain
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8
Q

In what situations should each patient be assessed for pain?

A
  • When mobile
  • When taking a deep breath
  • When in bed
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9
Q

What does inadequate control of post-operative pain result in?

A

Slower recovery

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10
Q

Give 2 examples of how poor post-operative pain control can lead to slower recovery?

A
  • Patients with poorly controlled pain are often reluctant to mobilise, in turn resulting in slower restoration of function and rehabilitation capacity
  • Patients in pain following abdominal surgery will not breath as deeply as they normally wound, resulting in adequate ventilation and subsequent atelectasis and hospital acquired pneumonia
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11
Q

What is the best known method for approaching pain relief?

A

The WHO analgesic ladder

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12
Q

What does the WHO analgesic ladder provide?

A

A strategy for titrating analgesia

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13
Q

What is started with on the WHO analgesic ladder?

A

Simple analgesics such as paracetamol or NSAIDs

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14
Q

What should be done if simple analgesics are not controlling pain well enough?

A

Should move up to the next stage of the ladder, and consider prescribing weak opiates, such as codeine or tramadol

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15
Q

What should be done if weak opiates are not controlled pain adequately?

A

Move up to the next step, and prescribe morphine or other stronger opiates

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16
Q

What can be done if stronger opiates are not sufficient?

A

Consider alternatives to the oral route, such as topical, intravenous, or subcutaneous

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17
Q

What can be done if parenteral strong opiates fails, and sinister causes of pain have been ruled out?

A

Consider specialist help and/or a patient-controlled analgesia pump

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18
Q

What might neuropathic pain respond better to?

A

Alternative analgesics such as amitriptyline or gabapentin

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19
Q

What should be done as patients recover, regarding pain management?

A

It is important to move down the ladder, and wean down the analgesia to a simple regime

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20
Q

What does non-opioid analgesia consist of?

A

Paracetamol and/or NSAIDs

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21
Q

Give two examples of NSAIDs

A
  • Diclofenac
  • Ibuprofen
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22
Q

How do NSAIDs work?

A

By inhibiting the synthesis of prostaglandins, thereby reducing the potential inflammatory response causing the pain

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23
Q

What are the adverse effects of NSAIDs?

A
  • Interactions with other medications, e.g. warfarin
  • Gastric ulceration
  • Renal impairment
  • Can trigger asthma
  • Bleeding risk
24
Q

What are opiates divded into?

A
  • Weak opiates
  • Strong opiates
25
Q

Give three examples of strong opiates

A
  • Morphine
  • Oxycodine
  • Fentanyl
26
Q

How do opiates work?

A

By activating the opiod receptors (MOP, DOP, and KOP), which are distibuted throughout the central nervous system

27
Q

What side effect will most patients on opiates experience?

A

Constipation and nausea

28
Q

How are the side effects of constipation and nausea with opiates dealt with?

A

Concurrent prescription of laxatives and anti-emetics

29
Q

What are the other side effects of opiates?

A
  • Sedation
  • Confusion
  • Respiratory depression
  • Pruritis
  • Tolerance and dependance
30
Q

What should be prescribed if regular opiates are needed?

A

Concurrent regular paracetamol

31
Q

Why should concurrent regular paracetamol be prescribed alongside regular opiates?

A

To reduce their requirements

32
Q

Can weak and strong opiates be used in combination?

A

This should be avoided

33
Q

Why should you avoid weak and strong opiates in combination?

A

As they competitively inhibit the same receptor to varying degrees

34
Q

What should be done if PRN opiates are frequently called for?

A

You should assess the 24-hour opiate requirement, and consider titration into a regular basal dose of modified release preparations

35
Q

What drug should be used if opioid analgesia is required in a patient with renal impairment?

A

Consider oxycodone or fentanyl rather than morphine

36
Q

What should be done if the oral route is contraindicated when providing analgesia?

A

Consider topical patches and use IV morphine for breakthrough analgesia

37
Q

How does the bioavailability compare between different routes of administration of morphine?

A

The bioavailability of oral morphine is 30%, whereas it is 80% for IV or SC morphine

38
Q

How long does morphine take to work if given intravenously?

A

20 minutes

39
Q

How long does morphine take to work if given orally?

A

20 minutes

40
Q

How long does morphine take to work if given intramuscularly?

A

15 minutes

41
Q

When might patient controlled analgesia be required post-operatively?

A

Post-operatively, many patients require more intense or immediate analgesia, and their requirements exceed the capacity of what the nursing staff can provide

42
Q

What does patient controlled analgesia involve?

A

The use of IV pumps that provide a bolus dose of an analgesic when the patient presses a button

43
Q

Where are patient controlled analgesia pumps started?

A

Usually in theatre or on the wards

44
Q

What is the decision to start a patient controlled analgesia pump in theatre based on?

A

Clinical experience of analgesia requirements of the specific operation by the surgical staff

45
Q

What are the advantages of patient controlled analgesia?

A
  • Provides analgesia that is tailored to the patients requirements
  • Safe - the risk of overdose is negligible
  • Can accurately record how much opoid is being administered, which can be converted to a regular dose
46
Q

What are the disadvantages of patient controlled analgesia?

A
  • Can be cumbersome and prevent the patient from mobilising
  • Not appropriate for those with poor manual dexterity or learning difficulties
47
Q

What does neuropathic pain result from?

A

Irritation or injury directly to the nerves, either peripherally or centrally

48
Q

How does neuropathic pain present?

A

Shooting or stabbing pains, can be described as like an electrical shock

49
Q

What is the prevalence of neuropathic pain following surgery?

A

As high as 10%

50
Q

After what surgeries is neuropathic pain frequently encounted?

A

After orthopedic or vascular surgery, particularly in amputees

51
Q

Why is neuropathic pain common in amputees?

A

Due to the nerve damage sustained when the limb is severed

52
Q

What can the management of neuropathic pain be split into?

A

Pharmacological and non-pharmacological methods

53
Q

What offers the best results in the management of neuropathic pain?

A

A combination of approaches

54
Q

What non-pharmacological treatment can be used in neuropathic pain?

A
  • Cognitive behavioural therapy
  • Transcutaneous electric nerve stimulation
  • Capsaicin cream
55
Q

What are the pharmacological therapies used in neuropathic pain?

A
  • Gabapentin
  • Amitriptyline
  • Pregabalin

Peri-Operative Care [16] (20 decks)

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