PACUs ANALGESIA DR. FATMA ALDAMMAS. PAIN An unpleasant sensory and emotional experience associated...
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Transcript of PACUs ANALGESIA DR. FATMA ALDAMMAS. PAIN An unpleasant sensory and emotional experience associated...
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PACUs ANALGESIAPACUs ANALGESIA
DR . FATMA ALDAMMASDR . FATMA ALDAMMAS
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PAINPAIN
• 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)
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PACUs ANALGESIAPACUs ANALGESIA
Postoperative pain differs from other types of pain
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PACUs ANALGESIAPACUs ANALGESIA
CAUSES OF VARIATION IN ANALGESIC REQUIREMENTS
• Site and type of surgery• Age, gender and body weight• Psychological factors • Pharmacokinetic variability• Pharmacodynamic variability
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PACUs ANALGESIAPACUs 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.
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PACUs ANALGESIAPACUs ANALGESIA
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PACUs ANALGESIAPACUs 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.
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PACUs ANALGESIAPACUs 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.
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PACUs ANALGESIAPACUs ANALGESIA
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PACUs ANALGESIAPACUs ANALGESIA
Pharmacokinetic variability
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PACUs ANALGESIAPACUs ANALGESIA
• Pharmacodynamic variability
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PACUs ANALGESIAPACUs ANALGESIA
Methods of treating pain in PACUsMethods of treating pain in PACUs
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Methods of treating pain in PACUsMethods of treating pain in PACUs
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Methods of treating pain in PACUsMethods of treating pain in PACUs
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Methods of treating painMethods of treating painin PACUsin 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 .
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PAIN CYCLEI.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
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Relationship of mode of delivery of analgesia to Relationship of mode of delivery of analgesia to serum analgesic levelserum analgesic level
• IM and IV PCA
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Methods of treating painMethods of treating painin PACUsin PACUs
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Methods of treating painMethods of treating painin PACUsin PACUs
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Methods of treating painMethods of treating painin PACUsin PACUs
ALGORITHMS FOR OPIOID ADMINISTRATION
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Methods of treating painMethods of treating painin PACUsin 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 .
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Methods of treating painMethods of treating painin PACUsin PACUs
The actions of morphine are:• • 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
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Methods of treating painMethods of treating painin PACUsin PACUs
PARENTERAL ROUTES OF OPIOID ADMINISTRATION
• Bolus i.v. administration• Continuous i.v. infusion• PCA
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MethodsMethods of treating painof treating painin PACUsin PACUs
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PCAPCA
• 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
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Relationship of mode of delivery of analgesia to Relationship of mode of delivery of analgesia to serum analgesic levelserum analgesic level
• IM and IV PCA
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Methods of treating painMethods of treating painin PACUsin PACUs
PARENTERAL ROUTES OF OPIOID ADMINISTRATION
patient-controlled analgesia (PCA)•
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Methods of treating painMethods of treating painin PACUsin 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
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Methods of treating painMethods of treating painin PACUsin PACUs