Pain Control
Upcoming SlideShare
Loading in...5
×

Like this? Share it with your network

Share
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
789
On Slideshare
787
From Embeds
2
Number of Embeds
1

Actions

Shares
Downloads
17
Comments
0
Likes
0

Embeds 2

http://www.slideshare.net 2

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide
  • Salicylic acid was first isolated from willow bark.
  • Salicylic acid purified from this in 1835, allowed mass production.

Transcript

  • 1. Pain Control.
  • 2. Pain Control Methods.
    • Pharmacological methods.
      • How to decide where to start.
      • Individual drugs.
    • Non-pharmacological methods.
      • Physical methods.
      • Psychological methods.
  • 3. What is pain?
    • “ An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Each individual learns the application of the word through experiences related to injury in early life.”
    • “ Pain is what the patient says it is.”
    .
  • 4. Pharmacological Methods of Pain Control.
    • Paracetamol
    • NSAIDS
    • Opiates
    • Local Anaesthetics
    • Nitrous Oxide
    • Medications aimed at treating the underlying pathology e.g. GTN for Angina
    .
  • 5. WHO Pain Ladder. .
  • 6. Paracetamol. .
  • 7. Paracetamol.
    • Weak inhibitor of prostaglandin synthesis.
    • However no anti-inflammatory effect.
    • Is there another mechanism of action?
    .
  • 8. Paracetamol.
    • Side effects.
    • Rashes
    • Renal Impairment
    • Increased risk of hepato-toxicity in liver failure.
    .
  • 9. Aspirin. .
  • 10. Meadowsweet. .
  • 11. NSAIDs
    • Mechanism of action
    • Inhibition of cyclo-oxygenase enzyme that converts Platelet Activating Factor into Prostaglandins.
    .
  • 12. NSAIDs
    • Cautions and Contraindications.
    • Hypersensitivity to Aspirin or NSAIDs
    • Active Peptic Ulceration.
    • Pregnancy – premature closure of Ductus Arteriosus.
    • Renal Impairment.
    .
  • 13. NSAIDs
    • Side effects.
    • Hypersensitivity.
    • GI Bleeding – less common with Ibuprofen
    • Bronchospasm.
    • Renal failure.
    • Fluid retention.
    .
  • 14. Opiates. .
  • 15. Opiates.
    • Mechanism of action –
    • Agonists/Partial Agonists at mu type Opiate Receptors.
    • These are mainly in CNS, but also found in other tissues.
    .
  • 16. Opiates.
    • Side effects.
    • Type A – Related to opiate receptors inside CNS.
    • Hallucinations.
    • Dysphoria.
    • Respiratory depression.
    • Vomiting.
    • Related to opiate receptors outside CNS.
    • Constipation.
    • Urinary retention.
    • Hypotension.
    .
  • 17. Opiates.
    • Type B - Non opiate receptor mediated histamine release.
    • Urticaria
    • Anaphylaxis
    • ARDS
    • These usually respond to anti-histamines not naloxone.
    .
  • 18. Local Anaesthetics. .
  • 19. Novocaine. .
  • 20. Local Anaesthetics.
    • Mechanism of action.
    • Defuse into axons in non ionised form.
    • Ionised form blocks fast sodium channels from the inside.
    .
  • 21. Local Anaesthetics.
    • Side effects - CNS.
    • Circumoral numbness.
    • Lightheadedness.
    • Tinnitus.
    • Convulsions.
    • Coma.
    • Respiratory arrest.
    .
  • 22. Local Anaesthetics.
    • Side effects - CVS.
    • Bradydysrhythmias.
    • Loss of vasomotor tone.
    • Ventricular tachydysrhythmias.
    • Also,
    • Allergic reactions.
    • Nerve injuries.
    • Infarction of appendages with adrenaline.
    • Pain at injection site.
    .
  • 23. Local Anaesthetics.
    • Lignocaine 3mg/kg
    • (double mixed with 1:200 000 adrenaline)
    • Bupivucaine 2mg/kg
    • Prilocaine 5mg/kg
    .
  • 24. Entonox.
    • Mixture of 50% Oxygen and 50% Nitrous Oxide.
    • Unknown mechanism of action.
    • Doesn’t cause respiratory depression.
    .
  • 25. Entonox.
    • Cautions and Contraindications.
    • Nitrous oxide defuses out of the blood
    • faster than Nitrogen dissolves into it.
    • Entonox should not be given in any situation where expansion of a gas filled space may have an adverse effect on the patient.
    .
  • 26. Entonox.
    • Cautions and Contraindications.
        • Pneumothorax
        • Intestinal Obstruction/Grossly distended abdomen.
        • Diving injuries.
        • Severe head injuries (maybe pneumocephalus)
        • Middle ear surgery.
        • Unconscious patients.
        • Severe facial trauma.
    .
  • 27. Other drugs.
    • Amitryptaline.
    • Gabapentin.
    .
  • 28. Non Pharmacological methods of pain control.
    • Physical.
    • Psychological.
    .
  • 29. Stabilisation. .
  • 30. “ Rubbing it better”
    • Gate theory of pain
    • Topical preparations
    • Acupressure?
    • Kober A, Scheck T, Greher M, Lieba F, Fleischhackl R, Fleischhackl S, Randunsky F, Hoerauf K (2002).
    • Prehospital analgesia with acupressure in victims of minor trauma: a prospective, randomised, double blinded trial.
    • Anaesth Analg 95(3) 723-727.
    .
  • 31. Non-pharmacological methods of Pain Control. .
  • 32. Remember a time when you were alone and afraid? .
  • 33. Remember a time when you were happy? .
  • 34. “ children tolerate pain well” .
  • 35. Distraction. .
  • 36. Any questions?
    • ?
    .
  • 37. Summary.
    • How to choose which drugs to use for pain control based on;
      • Aetiology of pain.
      • Amount of pain.
      • Individual drugs.
    • Physical methods of pain control.
    • Psychological methods of pain control.
    .
  • 38. Thank You. .