A talk by Stephan Schug at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
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Acute pain after surgery - lessons learned from the last decade - Stephan Schug - SSAI2017
1. Acute Pain after Surgery:
Lessons Learned from the Last Decade
Stephan A Schug
Anaesthesiology & Pain Medicine
University of Western Australia
Royal Perth Hospital
2. Disclosure
The Anaesthesiology Unit of the University of
Western Australia, but not Professor Schug
personally, has received research and travel funding
and speaking and consulting honoraria from Eli Lilly,
bioCSL/Seqirus, Grunenthal, Indivior, Janssen,
Mundipharma, Pfizer, Phosphagenics and
iXBiopharma within the last 5 years.
7. Opioids – the Good
Opioids are very effective analgesics
Opioids are necessary to provide pain relief in many
situations linked to severe pain:
– postoperative
– after severe trauma
Schug et al. Acute Pain Management: Scientific Evidence 4th edition ANZCA&FPMANZA
8. Opioids – the Bad
Opioids are often associated with adverse events including:
– Opioid-Induced Ventilatory Impairment
– Nausea and vomiting
– Constipation
– Urinary retention
– Sedation
– Confusion or agitation
– Rash, itching, hives
– Opioid-Induced Hyperalgesia
Opioid-related AEs increase length of stay and costs
Oderda GM, et al. J Pain Symptom Manage. 2003;25:276-83. TJ et al. Anesth Analg. 2004;98:1665-73.
9. What Can We Do About
Adverse Effects of Postoperative Opioids?
Schug et al. Acute Pain Management: Scientific Evidence 4th edition ANZCA&FPMANZCA
11. Effects of Parecoxib/Valdecoxib with PCA
Morphine in Laparoscopic Cholecystectomy
Gan TJ, et al. Acta Anaesthesiol Scand 2004;48:1194
Risk of
1 CME*
p<0.01 for all results
*Clinically meaningful events caused by opioid symptom distress
–29.2%
–32.7% –34.4%
–31.0%
0
–5
–10
–15
–20
–25
–30
–35
Opioid
dose
Mean brief
pain inventory
severity
Opioid
symptom
distress score
Change(%)
12. 12
American Pain Society,
American Society of Regional Anesthesia and Pain Medicine,
and the American Society of Anesthesiologists
“The panel recommends that clinicians
offer multimodal analgesia,
or the use of a variety of analgesic
medications and techniques combined
with nonpharmacological interventions,
for the treatment of postoperative pain
in children and adults
(strong recommendation, high-quality
evidence).”
Note: Exact components of effective multimodal care will vary depending on the
patient, setting, and surgical procedure.
Chou R, et al. J Pain. 2016;17:131-57.
14. Peripheral and Central Sensitisation
Leads to Pain Amplification
Normal
pain response
Sensitised
pain response
Injury
X
HYPERALGESIA
Stimulus intensity
Pain intensity
for stimulus X
normal pain
response
Pain intensity
for stimulus X
sensitised
pain response
ALLODYNIA
Painintensity
10
8
6
4
2
0
14Adapted from: Gottschalk A, Smith DS. Am Fam Physician. 2001;63:1979-84.
26. Initiate multimodal analgesic techniques
– Minimise use of opioids
– Maximise use of non-opioid agents
– Use regional anaesthesia whenever possible
• Superior to opioids, especially in orthopaedic
patients
Use evidence-based, procedure-specific pain management
guidelines where available
– http://fpm.anzca.edu.au/Resources/Publications
– http://www.jpain.org/article/S1526-5900(15)00995-5/pdf
– http://www.postoppain.org
Conclusions
26