acute postoperative pain 2015 part 1.pptx

7/25/2019 Acute Postoperative Pain 2015 part 1.pptx

http://slidepdf.com/reader/full/acute-postoperative-pain-2015-part-1pptx 1/95

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Encyclopedia of Pain. G.F. Gebhart , Robert F. Schmidt . Springer; 2nd ed. 201Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#

http://www.amazon.com/s/ref=dp_byline_sr_book_1?ie=UTF8&text=G.F.+Gebhart&search-alias=books&field-author=G.F.+Gebhart&sort=relevancerank



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Encyclopedia of Pain. G.F. Gebhart , Robert F. Schmidt . Springer; 2nd ed. 201





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NOCICE.TORS CL-SSIFIC-TIONS

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The en#ire peripera#ive peri1 en&4pa""in$ prepera#ivin#erven#in"6 in#rapera#ive anal$e"ia6 an1 p"#pera#ive p4ana$e4en# (ie6 preven#ive anal$e"ia)




.ree4p#ive anal$e"ia :

-n an#in&i&ep#ive in#erven#in #ha# "#ar#" 7efre in&i"in an1 i" 4re ee&#ive in relievin$ a&'#ep"#pera#ive pain #han #he "a4e #rea#4en# "#ar#af#er "'r$er0

Regional ne$the$ia and Pain edicine # )ol!me 35, 6!mber 1, 7an!Febr!ary 2011 P




.reven#ive anal$e"ia:

I" ai4e1 # 7l&8 #he 1evelp4en# f "'"#aine1 p7ra1er 1e@ni#in in&l'1e" an0 re$i4en $iven a# a#i4e 1'rin$ #he peripera#ive peri1 #ha# !ill 7e a&n#rl painin1'&e1 "en"i#iza#in

Regional ne$the$ia and Pain edicine # )ol!me 35, 6!mber 1, 7an!Febr!ary 2011 P Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#

% a&'p'n&#'ri"#



The ra#inale fr pree4p#ive anal$e"ia !a" 7a"e1

inhi7i#in f #he 1evelp4en# f &en#ral "en"i#iza#

-l#h'$h a ver0 pp'lar an1 1i"&'""e1 #her06 a anal$e"i& #rea#4en# (ei#her peripheral r ne'ra?ia

7efre #he in&i"in 1e" n# re1'&e p"#pera#ive7ehavir" 7e0n1 #he e?pe&#e1 1'ra#in f #he anee&#




hen #he 7l&8 f n&i&ep#ive aeren#" 1i4ini"he

"'r$i&al in2'r0 i" a7le # reini#ia#e &en#ral "en"i#iza

Fr #he"e rea"n"6 #hi" #er4inl$0 ha" 7een a7a


.reven#ive -nal$e"ia



$

Thi" 1e@ni#in 7ra1l0 in&l'1e" an0 re$

$iven a# an0 #i4e 1'rin$ #he periperaperi1 #ha# i" a7le # &n#rl painin1'"en"i#iza#in




S4e pa#ien#" 4a0 alrea10 have e?i"#in$ a&'#e

&hrni& pain an1 1evelpe1 &en#ral "en"i#iza#in 7#he "'r$i&al in&i"in

The"e pa#ien#" !i#h pree?i"#in$ pain 4a0 have ev4re in#en"e pain in #he p"#pera#ive peri1




Ti4in$ f #he in#erven#in 4a0 n# 7e a" &lini&all0

i4pr#an# a" #her a"pe&#" f preven#ive anal$e"in#en"i#0 an1 1'ra#in f #he in#erven#in)

-n in#erven#in a14ini"#ere1 7efre #he "'r$i&al i" n# preven#a#ive if i# i" in&4ple#e r in"'&ien




Ma?i4al &lini&al 7ene@# i" 7"erve1 !hen &4ple

4'l#i"e$4en#al 7l&8a1e f n?i'" "#i4'li &&'re?#en"in f #hi" ee&# in# #he p"#pera#ive per




M*LTIMOD-L -..RO-CH T.ERIO.ER-TIGE RECOGER




The anal$e"i& 7ene@#" f &n#rp"#pera#ive pain are $enerall4a?i4ize1 !hen a 4'l#i41al"#ra#e$0 # fa&ili#a#e #he pa#ien#

&nvale"&en&e i" i4ple4en#e1


.rin&iple" f a 4'l#i41al "#ra#e$0 #hr'$h #he '"re$inal ane"#he#i& #e&hni3'e" an1 a &47ina#in



re$inal ane"#he#i& #e&hni3'e" an1 a &47ina#inanal$e"i& 1r'$" (ie6 4'l#i41al anal$e"ia) in&l'1&n#rl f p"#pera#ive pain # all! :

Earl0 47iliza#in

Earl0 en#eral n'#ri#in

-##en'a#in f #he peripera#ive "#re"" re"pn"e




The '"e f epi1'ral a14ini"#ere1 anal$e"i&

prvi1e "'perir anal$e"ia an1 ph0"il$i&7ene@#" an1 i" #herefre an in#e$ral par# f4'l#i41al appra&h




M'l#i41al anal$e"ia




M'l#i41al anal$e"ia &n"i"#" f '"in$ vari'" 4

# re1'&e pain6 #h'" prvi1in$ 4re ee&#ive ana!hile re1'&in$ 1"e" an1 "i1e ee&#"

. 9habahian., R.G!pta. "he ne$the$ia G!ide. cGra:8ill Ed!cation 2013


*"e re$inal #e&hni3'e" !hen p""i7le



*"e re$inal #e&hni3'e" !hen p""i7le:

Cn#in''" r "in$lein2e&#in peripheral nerve

Epi1'ral inf'"in"Nnpii1 anal$e"i&"

Opii1 anal$e"i&"

IG .C-

-12'van# 4e1i&a#in"

. 9habahian., R.G!pta. "he ne$the$ia G!ide. cGra:8ill Ed!cation 2013




Epi1'ral anal$e"ia r even 7e##er "pinal anal$e"ia 1e&

#he area f "e&n1ar0 4e&hani&al h0peral$e"ia "'rr'n1in$ #he !e$ #he e?#en# f &en#ral "en"i#iza#in af#er pen a71"'r$er0 an1 re1'&e" #he ri"8 f 1evelpin$ ..S. (A> 4n#h" 70 &4pari"n !i#h ;Q in pa#ien#" !i#h'#ne'ra?ial 7l&8)

-a*and<homme P, =e >oc9 . "he !$e of intraoperati*e epid!ral or $pinal analge$ia po$toperati*e hyperalge$ia and red!ce$ re$id!al pain after ma?or abdominal $!rge nae$the$iol @elg 2005; &A'(+ 3A34B.


N?i'" inp'#" a""&ia#e1 !i#h 7#h a714inal a#hra&i& "'r$er0 are &nve0e1 70 "e$4en#al (i e



#hra&i& "'r$er0 are &nve0e1 70 "e$4en#al (ie nerve") an1 he#er"e$4en#al (ie va$'" an1 phre

nerve") innerva#in There706 an ee&#ive 7l&8 f #he"e &4pnen#"re3'ire #he &47ina#in f 7#h anal$e"i& an1an#ih0peral$e"i& 1r'$"6 in #her !r1"6 #he '"e fpr#e&#ive anal$e"ia

-a*and<homme P, =e >oc9 . "he !$e of intraoperati*e epid!ral or $pinal anamod!late$ po$toperati*e hyperalge$ia and red!ce$ re$id!al pain after ma?or$!rgery. cta nae$the$iol @elg 2005; &A'(+ 3A34B.




S'7ane"#he#i& 1"e" f 8e#a4ine "#rn$l0 p#en#ia#e

anal$e"ia ei#her 70 a "'pra"pinal ee&# 7l&8in$ 7ra"en"i#iza#in r 70 an an#iin5a44a#r0 ee&#

Clni1ine6 1i"pla0" an#ih0peral$e"i& prper#ie" af#er n(in#ra#he&al an1 epi1'ral) 7'# n# "0"#e4i& a14ini"#r

=e >oc9 , -a*and<homme P. aterloo$ . "he Short8-a$ting nalge$ia and -ong8"erm nECect of /ntrathecal %lonidine in Patient$ Dndergoing %olonic S!rgery. ne$th nalg 200&&A2.




• In#raven'" li1&aine inf'"in ('p # ;

af#er #he pr&e1're) re1'&e" p"#pera#ive paini4prve" 7!el f'n&#in af#er 1i$e"#ive "'r$er0

• T1a#e6 a "in$le "#'10 ha" f'n1 a preven#ive e4n#h" af#er 7rea"# &an&er "'r$er0 in #er4" f .in&i1en&e (AAP ver"'" <Q<)

Grigora$ , -ee P, Sattar F, Shorten G. Perioperati*e intra*eno!$ lidocaine deincidence of per$i$tent pain after brea$t $!rgery. %lin 7 Pain 2013; 2'A(+ &5A


.a#ien#" 'n1er$in$ 4a2r a714inal r #hra&ipr&e1're" an1 !h par#i&ipa#e in a 4'l#i41al



pr&e1're" an1 !h par#i&ipa#e in a 4'l#i41al"#ra#e$0 :

Have a re1'&#in in hr4nal an1 4e#a7li& "#r

.re"erva#in f ##al710 pr#ein

Shr#er #i4e" # #ra&heal e?#'7a#in

L!er pain "&re"Earlier re#'rn f 7!el f'n&#in

Earlier f'l@ll4en# f IC* 1i"&har$e &ri#eria




TRE-TMENT METHODS




Man0 p#in" are availa7le fr #he #rea#4en# f

p"#pera#ive pain:

S0"#e4i& (ie6 pii1 an1 nnpii1) anal$e"i&"

Re$inal (ie6 ne'ra?ial an1 peripheral) anal$e"i&#e&hni3'e"


Mni#rin$ an1 D&'4en#a#in f ."#pera#ive

-nal$e"iaAnalgesic Medication

Medication, concentration, and dose ofd

Side %&ects

Cardiovascular: h'potensio



drugSettings of PCA device: demand dose,lockout interval, continuous infusionAmount of drug administered(including number of unsuccessful andsuccessful doses)imits set (e!g!, "# and $#hour limits ondose administered)Supplemental or breakthroughanalgesics

brad'cardia, or tach'cardiaespirator' status: respiratlevel of sedation

Nausea and vomiting, pruritretentionNeurologic eaminationAssessment of motor block and sensor' level%vidence of epidural hemat

R'#ine Mni#rin$

Gi#al "i$n": #e4pera#'re6 hear# ra#e6 7l1pre""'re6 re"pira#r0 ra#eavera$e pain "&re.ain "&re a# re"# an1 !i#h a&#ivi#0pain relief*"e f 7rea8#hr'$h 4e1i&a#in

In"#r'&#in" .rvi1e1

Trea#4en# f "i1e ee&#"Cn&'rren# '"e f #her CNS 1e.ara4e#er" fr #ri$$erin$ n#i@&verin$ ph0"i&ian.rvi"in f &n#a&# infr4a#in1a0" per !ee8) if pr7le4" &&E4er$en&0 anal$e"i& #rea#4en


acute postoperative pain 2015 part 1.pptx

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