postop complications & pain management Flashcards
1
Q
- highly sensitive to stretch, ischemia and inflammation
- Ache, dull, crampy, diffuse, spastic, gnawing, constant
A
visceral nociceptive
2
Q
- stimulation of nociceptors in ligaments, tendons,
bones, blood vessels, fascia and muscles - Broken bone, sprains
A
deep somatic nociceptive
3
Q
well-defined and easily located activation of nociceptors in skin or other superficial structures
A
superficial somatic nociceptive
4
Q
two pre-op local anesthetics
A
lidocaine
marcaine
5
Q
- Preferred mode of administering opioids for moderate/severe postop pain
- easy and minimizes risk for OD
- which 3 meds can be given like this?
A
Patient controlled analgesia (PCA)
hydromorphone, morphine, fentanyl
6
Q
- harder to dose bc of short half life but used in liver patients bc no first pass effect
- synthetic derivative of morphine; 100x more potent
A
fentanyl
7
Q
what anelgesia is MC used for epidurals vs spinals?
A
epidurals: fentanyl
spinals: bupivacaine (marcaine)
8
Q
how are postdural HA treated? (3)
A
rest, IVF, blood patch
9
Q
- rapid onset; semisynthetic opioid agonist
- IV meds
A
hydromorphone
10
Q
- IV med that reduces narcotic demand used for 48h postop
- works as antipyretic
A
acetaminophen (ofirmev)
11
Q
- potent NSAID used with caution in renal pts/elderly
- reduces narcotic demand
- can only be dosed for 5 days d/t renal risk
A
ketorolac (toradol)
12
Q
- most commonly used oral meds
- SE includes N/V, constipation, hypotension, sedation, respiratory dep, urinary retention
- easy to withdrawal
A
13
Q
- Long lasting pain control
- Patch stays on for up to 3 days
- Transmits opioid transdermally
- New adjunct to modern day pain contro
A
fentanyl/lidocaine patch
14
Q
- SE profile low
- Helpful with neuropathic pain by binding to Ca+ channels to decrease impulse conduction which increases GABA synthesis (inhibitory pathway to pain transmission)
- No ceiling drug – If pain not controlled, increase the dose
A
anticonvulsants
15
Q
- Produces pain relief by enhancing the descending pain inhibition pathway
- Helpful with neuropathic and phantom pain
- Can be helpful with insomnia and depression associated with pain
- Concerns about toxicity
A
TCA (amitriptyline)
16
Q
- Helpful for sleep, anxiety disorders and muscle
spasms - Can cause dependence, increased aggression
- Caution with elderly
- Avoid if possible
A
Benzos