Transcript LECTURE 9- Postoperative management DR

Lecture Title: PACUs ANALGESIA
Lecturer name: DR . FATMA ALDAMMAS
Lecture Date:
Lecture Objectives..
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
anxiety 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
Drug Absorbed
I.M.Given
Call Nurse
Nurse screens
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
• 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
Methods of treating pain
in PACUs