Preoperative and postoperative treatment of pain

Question 1

What three factors should pharmacological intervention of pain be based on?

Answer 1

Pre-emtive prevention
Mechanism based
Multimodal

Question 2

Describe pre-emptive prevention?

Answer 2

Prevention of wind-up, hyperalgesia, physiological changes associated with pain or side effects
It is the most effective means of controlling post-operative pain

Question 3

Describe pre-emptive pain assessment?

Answer 3

Patient state and surroundings
Excitement, fear and stress
General health
Current pain state
Age
Anticipated pain severity

Question 4

What surgery will produce the most pain?

Answer 4

Thoracotomy
Proximal joint surgery
Eye and aural surgery
Intensive tissue trauma

Question 5

Describe mechanism based

Answer 5

When the surgeon examines the cause of the pain and decides the best method for tackling it, e.g. NSAIDs for inflammation.
Transduction: NSAID
Transmission: LA and epidurals
Modulation: opioids, alpha-2-agonists

Question 6

Describe multimodal?

Answer 6

Reduces symptoms with increased effectiveness

Question 7

What is pre-emptive analgesia?

Answer 7

Used to prevent peripheral sensitisation
If analgesia is applied before the painful stimuli and tissue damage, hypersensitivity can be avoided and central sensitisation prevented
Diminishes PO pain

Question 8

What is preoperative analgesia?

Answer 8

Used to prevent acute nociceptive pain

Concerns about hepatic, cardiac and renal function

Question 9

What drugs may be used preoperatively for analgesia?

Answer 9

Opioids
NSAIDs
Alpha-2-agonists
Local anaesthetics

Question 10

Mechanism of action of NSAIDs?

Answer 10

Block COC enzyme resulting in anti-inflammatory, antipyretic and analgesic effects
Do not block COX2

Question 11

Examples of NSAIDs used preoperatively?

Answer 11

Meloxicam
Caprofen
Ketoprofen

Question 12

Examples of alpha-2-agonists used preoperatively?

Answer 12

Xylazine

Medetomidine

Question 13

Procedure for ending anaesthesia?

Answer 13

1. Nitrous oxide turned off 5m before to ensure adequate oxygenation
2. Endotracheal tube removed when swallowing reflex returns
3. Temperature taken

Question 14

What has to be monitored post operatively?

Answer 14

Temperature
Bloods
Urinary output
Fluid therapy
Medications used
Bleeding/wounds
Oxygen
HR, pulse and respiration