Surgery 2 Flashcards
1
Q
Pain management - drug misusers
A
- Pain management is a basic human right.
- Regular doses of methadone/buprenorphine does not provide an effective analgesic profile.
- Additional pain medication is required.
2
Q
Consequences of inappropriate pain management - drug misusers
A
- Relapse to addiction.
- Potentially fatal toxicity due to misjudged tolerance or drug interactions.
- Compromised medical care.
3
Q
Monitoring - drug misusers
A
- Pain score
- Respiratory depression
4
Q
Current guidlines - drug misuers
A
- Opioids are not contraindicated.
- Long-acting opioids are preferred.
- Wean as soon as possible.
- Buprenorphine can generally be continued
5
Q
Use of opioids
A
- Former addicts = small risk of exposure triggering relapse.
- Discuss with patient - they may prefer non-opioid analgesia.
- Support during and after discharge.
6
Q
Buprenorphine OST alternative treatment need
A
- Patients on buprenorphine OST may require alternative treatments to manage pain (non-opioid).
- Doses >12 mg may cause total blockage of µ-opioid receptor.
7
Q
Alternative non-opioid approaches
A
- Paracetamol
- NSAIDs
- Adjuvant medications (tricyclic antidepressants)
8
Q
Buprenorphine OST - incomplete blockage
A
- Opioids can be used, but higher doses required.
- If the patient wants to remain on buprenorphine = 6-8 hourly dosing regime to improve the pain management response.
9
Q
Venous Thromboembolism (VTE)
A
- Blood clot forms in vein.
- Commonly occurs in the deep veins of the legs (DVT).
10
Q
VTE - Clinical presentation
A
- Varies
- Often asymptomatic.
- Pain and swelling in the leg.
11
Q
Complications of VTE
A
- Pulmonary embolism (PE)
- Chronic venous insufficiency
- Venous ulceration
- Post-thrombotic limb
12
Q
Pulmonary embolism (PE)
A
- Part or all of thrombus dislodged from site of origin
- Travels in the blood to the lungs
- Potentially fatal PE
13
Q
Post-thrombotic limb
A
- Chronic pain
- Swelling
- Skin changes
14
Q
VTE - Pharmacological treatment
A
- LMWH
- Heparin
- Dabigatran
- Rivaroxaban
15
Q
VTE - non pharmacological treatment
A
- TEDs
- Foot pumps
- Flowtron intermittent pneumatic compression (IPC)