Transcript PACUs ANALGESIA

PACUs ANALGESIA
DR . FATMA ALDAMMAS
PAIN
• An unpleasant sensory and emotional experience
associated with actual or potential tissue damage
or described in terms of such damage.
( International association of study of pain)
PACUs ANALGESIA
Postoperative pain differs from other types of pain
PACUs ANALGESIA
CAUSES OF VARIATION IN ANALGESIC
REQUIREMENTS
• Site and type of surgery
• Age, gender and body weight
• Psychological factors
• Pharmacokinetic variability
• Pharmacodynamic variability
PACUs ANALGESIA
Site and type of surgery
• general, upper abdominal surgery produces greater
pain than lower abdominal surgers
• operation on the ritchly innervated digits associated
with severe pain.
• The type of pain differ with different types of surgery.
PACUs ANALGESIA
PACUs ANALGESIA
Age, gender and body weight
• analgesic requirements of males and females are
identical for similar types of surgery.
• There is a reduction in analgesic requirements with
advancing age.
PACUs ANALGESIA
Psychological factors
• the patient’s personality affects pain perception and
response to analgesic drugs.
• patients with a less anxiety exhibit less postoperative
pain and require smaller doses of opioid than patients
who rate highly on anxity scales.
PACUs ANALGESIA
PACUs ANALGESIA
Pharmacokinetic variability
PACUs ANALGESIA
• Pharmacodynamic
variability
PACUs ANALGESIA
Methods of treating pain in PACUs
Methods of treating pain in PACUs
Methods of treating pain in PACUs
Methods of treating pain
in PACUs
CONVENTIONAL ADMINISTRATION OF OPIOIDS
• Intramuscular administration of opioids on a pro re
nata (as required) basis is the method used most
commonly for prescribinig in PACUs .
• IM results in variable absorption (hypothermia
,hypotenion ,hypovolemia)
• Delay between request for analgesia and subsequent
administration .
PAIN CYCLE
I.M.prn analgesia require the patient to wait out the prescribed
Patient in Pain
Sedation
Call Nurse
Drug Absorbed
Nurse screens
I.M.Given
Meds Prepared
Traditional I.M.analgesia repetitive of pain
Relationship of mode of delivery of analgesia to
serum analgesic level
• IM and IV PCA
Methods of treating pain
in PACUs
Methods of treating pain
in PACUs
Methods of treating pain
in PACUs
ALGORITHMS FOR OPIOID ADMINISTRATION
Methods of treating pain
in PACUs
Sites of action and properties of morphine and
morphine-like drugs
• Opioids act supraspinally (nucleus raphe magnus,
periaqueductal and periventricular gray areas ) in the
spinal cord around (C -fibre terminals in lamina I and
the substantia gelatinosa, lamina II ),and peripherally
opioid receptors .
Methods of treating pain
in PACUs
The actions of morphine are:
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• Analgesia — morphine produces analgesia in binding with
opioid receptors
• Ventilarors depression
• Sedation
• Cough suppression
• vasodilatation
• Release of histamine
• Constipation
• Nausea and s vomiting
• Pupillary constriction
• Biliary spasm
• urine retention
• tolerance
• Physical dependence
Methods of treating pain
in PACUs
PARENTERAL ROUTES OF OPIOID ADMINISTRATION
• Bolus i.v. administration
• Continuous i.v. infusion
• PCA
Methods of treating pain
in PACUs
PCA
• PCA devices are modified infusion pumps that
allow patients to self-administer a small dose of
opioid intravenously, with least possible
intercession by anyone
• Allowing patient to titrate their level of analgesia
against the amount of pain they are
experiencing
Relationship of mode of delivery of analgesia to
serum analgesic level
• IM and IV PCA
Methods of treating pain
in PACUs
PARENTERAL ROUTES OF OPIOID ADMINISTRATION
patient-controlled analgesia (PCA)
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Methods of treating pain
in PACUs
• Moderate to severe postoperative pain in the PACU
can be managed with parenteral or intraspinal opioids,
regional anesthesia, or specific nerve blocks
• When an epidural catheter has been placed, epidural
administration of fentanyl, 50—100 µg, sufentanil,
20—30 µg, or morphine, 3—5 mg, can provide
excellent pain relief in adults .
• Wound infiltration with local anesthetic or intercostal,
interscalene, epidural, or caudal anesthesia is often
helpful
Methods of treating pain
in PACUs