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 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 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

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

Pharmacokinetic variability

PACUs ANALGESIA Pharmacodynamic variability

PACUs ANALGESIA 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

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: 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)

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