Pharmacist Educational Intervention in Intravenous Patient Controlled Analgesia is Associated with Decreased Postoperative PainPharmacist Educational Intervention in Intravenous Patient Controlled Analgesia is Associated with Decreased Postoperative Pain
Postoperative pain management is an essential component of surgical patient care. About 75% of surgical patients experience pain after a procedure. Effective pain control allows for early mobilization, reduced complications, and faster recovery. Postoperative pain arises from tissue damage during surgery and the subsequent inflammatory response. Both pharmacological and non-pharmacological methods can be used to treat postoperative pain, including opioids, NSAIDs, local anesthetics, and physical therapy. Proper assessment and an individualized treatment plan that utilizes a stepwise multimodal approach can provide pain relief and optimize patient outcomes.
The document discusses pain management standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001. These standards require facilities to properly assess, treat, and manage patient pain. It also discusses the differences between PRN ("as-needed") medication, where patients receive pain medication as requested, versus around-the-clock (ATC) scheduled dosing. Previous studies have found that ATC dosing results in better pain relief and fewer barriers to patients receiving adequate pain treatment compared to PRN dosing. This quality improvement study similarly found that ATC dosing was associated with lower reported pain levels without increasing adverse events.
This document presents the 2018 consensus statement of the Section of Regional Anaesthesia and Pain Therapy of the Polish Society of Anaesthesiology and Intensive Therapy on postoperative pain management. It provides guidelines and recommendations based on a review of the latest scientific evidence published since 2014. The guidelines cover appropriate use of opioids and other drugs for postoperative pain relief, and emphasize the importance of multimodal analgesia and the need to individualize treatment to the patient and surgery. Pethidine is not recommended due to concerns about its efficacy and safety profile compared to other opioids.
This document summarizes a presentation on anaesthesia and pain relief given by Dr. Annush Tha. It covers various topics including:
- Types of anaesthesia such as general, local, and regional anaesthesia along with their techniques and monitoring.
- Pre-anaesthetic evaluation and selection of anaesthetic technique based on factors like operative site and patient risk.
- Acute and chronic pain management with a focus on multimodal approaches using analgesics like opioids, NSAIDs, and local anaesthetics.
- Special considerations for pain control in malignant diseases and chronic pain conditions.
The key messages are that anaesthesia selection should be tailored per patient and surgery with cost in mind, multimodal pain
A 32-year-old pregnant woman at 29 weeks gestation presents to the ER with sudden onset of severe right flank pain radiating to her back and groin, associated with nausea and increased urination.
On examination, her vital signs are stable. The fetal heart sound is normal and there is no vaginal bleeding. Preliminary tests have been ordered.
The document discusses evaluating and treating pain using analgesics like paracetamol, NSAIDs, opioids, and adjuvants depending on the intensity of pain. Regional anesthesia techniques are also described.
For this pregnant patient, the document recommends treating her pain with paracetamol, NSAIDs initially given her gestational age and pain description. Close monitoring
This three-paragraph summary provides an overview of Sandhills Endoscopy Center's pain management policy:
The policy establishes a multi-disciplinary, patient-centered approach to pain management. It defines guiding principles that include commitment to the best level of pain control safely provided and acceptance of ethical responsibilities to manage and relieve pain.
The policy recognizes patients' rights to pain relief and management. It outlines assessment and treatment procedures, including discussing pain expectations pre-and-post procedures, monitoring pain levels, and using 0-10 or Wong-Baker scale tools to rate intensity.
Specific assessment includes location, intensity, character, and onset of pain. Effectiveness of treatment regimens is also evaluated to continually manage
This document discusses acute pain management in the emergency department. It begins with an introduction noting that pain is the most common presenting symptom in emergency departments, with over 60% of patients experiencing pain. It then focuses on defining acute pain and providing an overview of the pathophysiology of acute pain. The document also discusses common barriers to pain management in emergency settings, dos and don'ts of pain treatment, and strategies to improve pain management in the emergency department. It provides recommendations from international health organizations on patients' right to pain relief.
This document provides an overview of regional anesthesia techniques for total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA). It discusses the evidence regarding general versus regional anesthesia, as well as various regional techniques for intraoperative anesthesia and postoperative analgesia. While regional anesthesia is associated with improvements in some outcomes like pain control and reduced side effects, the evidence on other outcomes like infection rates and length of stay is mixed compared to general anesthesia. A variety of regional techniques can provide effective analgesia after TJA, including neuraxial blocks, peripheral nerve blocks, and extended-release epidural morphine, but they each have specific risks and benefits to consider.
Postoperative pain management is an essential component of surgical patient care. About 75% of surgical patients experience pain after a procedure. Effective pain control allows for early mobilization, reduced complications, and faster recovery. Postoperative pain arises from tissue damage during surgery and the subsequent inflammatory response. Both pharmacological and non-pharmacological methods can be used to treat postoperative pain, including opioids, NSAIDs, local anesthetics, and physical therapy. Proper assessment and an individualized treatment plan that utilizes a stepwise multimodal approach can provide pain relief and optimize patient outcomes.
The document discusses pain management standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001. These standards require facilities to properly assess, treat, and manage patient pain. It also discusses the differences between PRN ("as-needed") medication, where patients receive pain medication as requested, versus around-the-clock (ATC) scheduled dosing. Previous studies have found that ATC dosing results in better pain relief and fewer barriers to patients receiving adequate pain treatment compared to PRN dosing. This quality improvement study similarly found that ATC dosing was associated with lower reported pain levels without increasing adverse events.
This document presents the 2018 consensus statement of the Section of Regional Anaesthesia and Pain Therapy of the Polish Society of Anaesthesiology and Intensive Therapy on postoperative pain management. It provides guidelines and recommendations based on a review of the latest scientific evidence published since 2014. The guidelines cover appropriate use of opioids and other drugs for postoperative pain relief, and emphasize the importance of multimodal analgesia and the need to individualize treatment to the patient and surgery. Pethidine is not recommended due to concerns about its efficacy and safety profile compared to other opioids.
This document summarizes a presentation on anaesthesia and pain relief given by Dr. Annush Tha. It covers various topics including:
- Types of anaesthesia such as general, local, and regional anaesthesia along with their techniques and monitoring.
- Pre-anaesthetic evaluation and selection of anaesthetic technique based on factors like operative site and patient risk.
- Acute and chronic pain management with a focus on multimodal approaches using analgesics like opioids, NSAIDs, and local anaesthetics.
- Special considerations for pain control in malignant diseases and chronic pain conditions.
The key messages are that anaesthesia selection should be tailored per patient and surgery with cost in mind, multimodal pain
A 32-year-old pregnant woman at 29 weeks gestation presents to the ER with sudden onset of severe right flank pain radiating to her back and groin, associated with nausea and increased urination.
On examination, her vital signs are stable. The fetal heart sound is normal and there is no vaginal bleeding. Preliminary tests have been ordered.
The document discusses evaluating and treating pain using analgesics like paracetamol, NSAIDs, opioids, and adjuvants depending on the intensity of pain. Regional anesthesia techniques are also described.
For this pregnant patient, the document recommends treating her pain with paracetamol, NSAIDs initially given her gestational age and pain description. Close monitoring
This three-paragraph summary provides an overview of Sandhills Endoscopy Center's pain management policy:
The policy establishes a multi-disciplinary, patient-centered approach to pain management. It defines guiding principles that include commitment to the best level of pain control safely provided and acceptance of ethical responsibilities to manage and relieve pain.
The policy recognizes patients' rights to pain relief and management. It outlines assessment and treatment procedures, including discussing pain expectations pre-and-post procedures, monitoring pain levels, and using 0-10 or Wong-Baker scale tools to rate intensity.
Specific assessment includes location, intensity, character, and onset of pain. Effectiveness of treatment regimens is also evaluated to continually manage
This document discusses acute pain management in the emergency department. It begins with an introduction noting that pain is the most common presenting symptom in emergency departments, with over 60% of patients experiencing pain. It then focuses on defining acute pain and providing an overview of the pathophysiology of acute pain. The document also discusses common barriers to pain management in emergency settings, dos and don'ts of pain treatment, and strategies to improve pain management in the emergency department. It provides recommendations from international health organizations on patients' right to pain relief.
This document provides an overview of regional anesthesia techniques for total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA). It discusses the evidence regarding general versus regional anesthesia, as well as various regional techniques for intraoperative anesthesia and postoperative analgesia. While regional anesthesia is associated with improvements in some outcomes like pain control and reduced side effects, the evidence on other outcomes like infection rates and length of stay is mixed compared to general anesthesia. A variety of regional techniques can provide effective analgesia after TJA, including neuraxial blocks, peripheral nerve blocks, and extended-release epidural morphine, but they each have specific risks and benefits to consider.
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document provides an overview of pain management and opioid use for cancer patients. It discusses how cancer pain is common and should be properly assessed and treated. The WHO pain ladder is reviewed as the standard approach for treating pain with non-opioids, weak opioids, and strong opioids. Opioid rotation and treating pain crises are covered, including calculating opioid conversions and administering parenteral opioids. Challenges in treating cancer pain in patients with addiction histories are addressed through transparency, long-acting opioids, and pain contracts. Overall guidelines aim to properly treat pain while avoiding exacerbating addiction issues.
This clinical review provides an overview of pain management for hospice and palliative care patients. It describes the prevalence of pain, barriers to treatment, and impact of uncontrolled pain. Guidelines for assessment, non-opioid and opioid medication use, and adjuvant therapies are presented. Effective communication and an interdisciplinary approach are emphasized for comprehensive pain management.
1) Balanced anesthesia aims to achieve loss of consciousness, memory, pain, and muscle tone. It involves preoperative, intraoperative, and postoperative management.
2) Preoperative management includes obtaining history, performing examination, ordering relevant investigations, and administering premedication. Key parts of examination focus on cardiovascular, respiratory, airway, and neurological systems.
3) Intraoperative management consists of monitoring, positioning the patient, selecting anesthesia technique, inducing and maintaining anesthesia, administering fluids, and performing extubation and recovery.
4) Postoperative management involves transferring the patient, providing pain management, and addressing any complications.
Overview on pain management in MSF setting. Content:
Types of pain
Assess the pain and pain scales
Treating pain according to the pain scale
All of subjected will be discussed briefly and in perspective of our work
MATERIALS:
https://emedicine.medscape.com/article/1948069-overview#a3
https://www.change-pain.com/grt-change-pain-portal/change_pain_home/chronic_pain/physician/physician_tools/picture_library/en_EN/312500026.jsp
MSF Clinical Guidelines and MSF protocols
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
Bloqueo abdominal guiado por usg en niñosmireya juarez
Ultrasound guided Transverses Abdominal Plane Block versus Ilioinguinal/iliohypogastric Nerve Blocks for Postoperative Analgesia in Children Undergoing Lower Abdominal Surgery. Sixty children scheduled for lower abdominal surgery were randomized to receive either a TAP block or ilioinguinal/iliohypogastric nerve block. Pain scores were recorded and rescue analgesia was provided when needed. The average time to first rescue analgesia was longer in the TAP block group compared to the nerve block group. TAP block provided longer lasting postoperative pain relief than ilioinguinal/iliohypogastric nerve blockade.
This document discusses optimizing pain management in cancer treatment. It provides an overview of concepts like total pain, the WHO analgesic ladder for treating pain with opioids, and the importance of proper pain assessment and documentation. The key points are:
1) Total pain includes physical, psychosocial, emotional, and spiritual suffering experienced by cancer patients.
2) The WHO analgesic ladder recommends treating mild pain with non-opioids like paracetamol, moderate pain with weak opioids like codeine, and severe pain with strong opioids like morphine.
3) Proper pain assessment involves documenting pain scores, characteristics, causes, and impact on function to effectively guide pain treatment decisions.
This document provides an overview of chronic pain management. It defines chronic pain and discusses its classification, mechanisms, evaluation, and multimodal treatment approaches. Chronic pain is defined as pain persisting beyond tissue healing, usually 3-6 months. Treatment involves a multimodal approach including drug therapies, psychological therapies, rehabilitation, anesthesiological techniques, neurostimulation, lifestyle changes, and complementary therapies. Specific treatment modalities discussed include various pharmacological interventions, cognitive-behavioral therapy, biofeedback, and spinal cord stimulation.
Different types of anesthesia by john gerancherJohn Gerancher
Dr. John Gerancher was a pioneer in the field of anesthesiology. He was responsible for developing the clinical care area, teaching program, and regional anesthesia section at Wake Forest Baptist Medical Center. Dr. Gerancher also designed and implemented a computer information system for the operating room called the John Galt. He was licensed to practice medicine in Washington, North Carolina, and California. The document then provides descriptions of the different types of anesthesia administered to patients: general, local, and regional.
Pain is one of the most challenging problem in medicine and biology:
A challenge to the suffer --> learn live with pain.
A challenge to the physician --> seeks every possible means to help the patient
A challenge to the scientist --> who tries to understand the mechanism of terrible suffering.
It is also a challenge to society --> find financial to relieve or prevent the pain and suffering.
This document discusses pain, including definitions of pain, types of pain, factors influencing pain, effects of pain, individual variations in pain response, and pain assessment tools. It also covers postoperative pain management principles like the WHO pain ladder, pharmacological and non-pharmacological interventions for pain control, preemptive analgesia using local anesthetics or other drugs before a painful stimulus to reduce later pain, and techniques like patient-controlled analgesia and epidural analgesia. The goal of pain management is to prevent pain from interfering with recovery through adequate assessment and treatment.
This document describes the background and findings of Maarten Loos' thesis on the surgical management of chronic inguinal pain syndromes. It provides details about Loos' education and research focusing on chronic pain after hernia repair and Pfannenstiel incisions. The summary describes Loos' research finding high rates of chronic pain after these procedures, identifying nerve entrapment as a common cause. It also outlines Loos' classification of post-herniorrhaphy pain syndromes and studies evaluating treatments like nerve blocks and neurectomy.
Acute pain after surgery - lessons learned from the last decade - Stephan Sch...scanFOAM
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/
This document provides an overview of general anesthesia. It defines general anesthesia as a reversible state of unconsciousness with inability to respond to pain. It then briefly discusses the history of general anesthesia and compares it to local anesthesia and conscious sedation. The rest of the document details various aspects of general anesthesia including pre-anesthetic checkups, airway assessments, induction, maintenance, emergence, postoperative care, complications and their management, as well as advantages, disadvantages, contraindications and indications for general anesthesia.
This document discusses different types of anesthesia used in surgery. It describes general anesthesia as making the patient completely unconscious using intravenous drugs and inhaled gases. Regional anesthesia involves injecting local anesthetics around nerves or the spinal cord to numb a specific body region. Local anesthesia temporarily stops pain sensation in a localized area using injections. The stages and phases of general anesthesia are also outlined, including induction to prepare the patient, maintenance during surgery, and recovery afterward. Risks of anesthesia are generally low but can include side effects like nausea, depending on individual health factors.
This document provides an overview of anaesthesia. It discusses the four stages of anaesthesia: analgesia, excitement, surgical anaesthesia, and medullary paralysis. It also describes the three main types of anaesthesia: general anaesthesia, which induces unconsciousness; regional anaesthesia, which blocks pain in a limited body region; and local anaesthesia, which blocks pain in a small area. Finally, it outlines several common anaesthetic drugs, including pentobarbitone sodium, urethane, chloralose, ether, paraldehyde, halothane, nitrous oxide, and magnesium sulphate, and provides brief details on their uses and dosages.
Austin Pain & Relief is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pain & Relief.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pain & Relief. Austin Pain & Relief accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pain and relief.
Austin Pain & Relief strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
The document summarizes a systematic review that analyzed 15 randomized controlled trials on the use of acupuncture and related techniques for postoperative pain management. The review found that acupuncture was associated with significant reductions in postoperative opioid consumption, pain intensity, and opioid-related side effects such as nausea, dizziness, and sedation, compared to sham controls. Specifically, acupuncture reduced opioid use by 23-29 mg at 8-72 hours postoperatively and decreased pain scores at 8 and 72 hours. The studies involved a variety of surgeries and acupuncture methods.
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document provides an overview of pain management and opioid use for cancer patients. It discusses how cancer pain is common and should be properly assessed and treated. The WHO pain ladder is reviewed as the standard approach for treating pain with non-opioids, weak opioids, and strong opioids. Opioid rotation and treating pain crises are covered, including calculating opioid conversions and administering parenteral opioids. Challenges in treating cancer pain in patients with addiction histories are addressed through transparency, long-acting opioids, and pain contracts. Overall guidelines aim to properly treat pain while avoiding exacerbating addiction issues.
This clinical review provides an overview of pain management for hospice and palliative care patients. It describes the prevalence of pain, barriers to treatment, and impact of uncontrolled pain. Guidelines for assessment, non-opioid and opioid medication use, and adjuvant therapies are presented. Effective communication and an interdisciplinary approach are emphasized for comprehensive pain management.
1) Balanced anesthesia aims to achieve loss of consciousness, memory, pain, and muscle tone. It involves preoperative, intraoperative, and postoperative management.
2) Preoperative management includes obtaining history, performing examination, ordering relevant investigations, and administering premedication. Key parts of examination focus on cardiovascular, respiratory, airway, and neurological systems.
3) Intraoperative management consists of monitoring, positioning the patient, selecting anesthesia technique, inducing and maintaining anesthesia, administering fluids, and performing extubation and recovery.
4) Postoperative management involves transferring the patient, providing pain management, and addressing any complications.
Overview on pain management in MSF setting. Content:
Types of pain
Assess the pain and pain scales
Treating pain according to the pain scale
All of subjected will be discussed briefly and in perspective of our work
MATERIALS:
https://emedicine.medscape.com/article/1948069-overview#a3
https://www.change-pain.com/grt-change-pain-portal/change_pain_home/chronic_pain/physician/physician_tools/picture_library/en_EN/312500026.jsp
MSF Clinical Guidelines and MSF protocols
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
Bloqueo abdominal guiado por usg en niñosmireya juarez
Ultrasound guided Transverses Abdominal Plane Block versus Ilioinguinal/iliohypogastric Nerve Blocks for Postoperative Analgesia in Children Undergoing Lower Abdominal Surgery. Sixty children scheduled for lower abdominal surgery were randomized to receive either a TAP block or ilioinguinal/iliohypogastric nerve block. Pain scores were recorded and rescue analgesia was provided when needed. The average time to first rescue analgesia was longer in the TAP block group compared to the nerve block group. TAP block provided longer lasting postoperative pain relief than ilioinguinal/iliohypogastric nerve blockade.
This document discusses optimizing pain management in cancer treatment. It provides an overview of concepts like total pain, the WHO analgesic ladder for treating pain with opioids, and the importance of proper pain assessment and documentation. The key points are:
1) Total pain includes physical, psychosocial, emotional, and spiritual suffering experienced by cancer patients.
2) The WHO analgesic ladder recommends treating mild pain with non-opioids like paracetamol, moderate pain with weak opioids like codeine, and severe pain with strong opioids like morphine.
3) Proper pain assessment involves documenting pain scores, characteristics, causes, and impact on function to effectively guide pain treatment decisions.
This document provides an overview of chronic pain management. It defines chronic pain and discusses its classification, mechanisms, evaluation, and multimodal treatment approaches. Chronic pain is defined as pain persisting beyond tissue healing, usually 3-6 months. Treatment involves a multimodal approach including drug therapies, psychological therapies, rehabilitation, anesthesiological techniques, neurostimulation, lifestyle changes, and complementary therapies. Specific treatment modalities discussed include various pharmacological interventions, cognitive-behavioral therapy, biofeedback, and spinal cord stimulation.
Different types of anesthesia by john gerancherJohn Gerancher
Dr. John Gerancher was a pioneer in the field of anesthesiology. He was responsible for developing the clinical care area, teaching program, and regional anesthesia section at Wake Forest Baptist Medical Center. Dr. Gerancher also designed and implemented a computer information system for the operating room called the John Galt. He was licensed to practice medicine in Washington, North Carolina, and California. The document then provides descriptions of the different types of anesthesia administered to patients: general, local, and regional.
Pain is one of the most challenging problem in medicine and biology:
A challenge to the suffer --> learn live with pain.
A challenge to the physician --> seeks every possible means to help the patient
A challenge to the scientist --> who tries to understand the mechanism of terrible suffering.
It is also a challenge to society --> find financial to relieve or prevent the pain and suffering.
This document discusses pain, including definitions of pain, types of pain, factors influencing pain, effects of pain, individual variations in pain response, and pain assessment tools. It also covers postoperative pain management principles like the WHO pain ladder, pharmacological and non-pharmacological interventions for pain control, preemptive analgesia using local anesthetics or other drugs before a painful stimulus to reduce later pain, and techniques like patient-controlled analgesia and epidural analgesia. The goal of pain management is to prevent pain from interfering with recovery through adequate assessment and treatment.
This document describes the background and findings of Maarten Loos' thesis on the surgical management of chronic inguinal pain syndromes. It provides details about Loos' education and research focusing on chronic pain after hernia repair and Pfannenstiel incisions. The summary describes Loos' research finding high rates of chronic pain after these procedures, identifying nerve entrapment as a common cause. It also outlines Loos' classification of post-herniorrhaphy pain syndromes and studies evaluating treatments like nerve blocks and neurectomy.
Acute pain after surgery - lessons learned from the last decade - Stephan Sch...scanFOAM
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/
This document provides an overview of general anesthesia. It defines general anesthesia as a reversible state of unconsciousness with inability to respond to pain. It then briefly discusses the history of general anesthesia and compares it to local anesthesia and conscious sedation. The rest of the document details various aspects of general anesthesia including pre-anesthetic checkups, airway assessments, induction, maintenance, emergence, postoperative care, complications and their management, as well as advantages, disadvantages, contraindications and indications for general anesthesia.
This document discusses different types of anesthesia used in surgery. It describes general anesthesia as making the patient completely unconscious using intravenous drugs and inhaled gases. Regional anesthesia involves injecting local anesthetics around nerves or the spinal cord to numb a specific body region. Local anesthesia temporarily stops pain sensation in a localized area using injections. The stages and phases of general anesthesia are also outlined, including induction to prepare the patient, maintenance during surgery, and recovery afterward. Risks of anesthesia are generally low but can include side effects like nausea, depending on individual health factors.
This document provides an overview of anaesthesia. It discusses the four stages of anaesthesia: analgesia, excitement, surgical anaesthesia, and medullary paralysis. It also describes the three main types of anaesthesia: general anaesthesia, which induces unconsciousness; regional anaesthesia, which blocks pain in a limited body region; and local anaesthesia, which blocks pain in a small area. Finally, it outlines several common anaesthetic drugs, including pentobarbitone sodium, urethane, chloralose, ether, paraldehyde, halothane, nitrous oxide, and magnesium sulphate, and provides brief details on their uses and dosages.
Austin Pain & Relief is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pain & Relief.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pain & Relief. Austin Pain & Relief accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pain and relief.
Austin Pain & Relief strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
The document summarizes a systematic review that analyzed 15 randomized controlled trials on the use of acupuncture and related techniques for postoperative pain management. The review found that acupuncture was associated with significant reductions in postoperative opioid consumption, pain intensity, and opioid-related side effects such as nausea, dizziness, and sedation, compared to sham controls. Specifically, acupuncture reduced opioid use by 23-29 mg at 8-72 hours postoperatively and decreased pain scores at 8 and 72 hours. The studies involved a variety of surgeries and acupuncture methods.
This document discusses pain management. It defines different types of pain and outlines objectives for learners to understand pain pathophysiology, assessment, and treatment methods. Pain is categorized as acute, chronic, or cancer-related. Factors influencing pain responses are described. Pharmacological interventions like opioids and NSAIDs are compared with non-pharmacological options. The nursing role in a pain management plan utilizing the nursing process is also summarized.
This document discusses pain and pain management. It begins with definitions of pain from organizations like the IASP and discusses how pain is subjective. It then covers types of pain like acute, chronic, and cancer pain. The document also discusses pain assessment, theories of pain transmission like the gate control theory, and advantages of conscious sedation for procedures. In summary, it provides an overview of perspectives on pain, classifications of pain, assessing pain, and uses of conscious sedation.
Dr. Shekhar Anand presented on methods of chronic pain management to the Department of Anesthesiology. He discussed that chronic pain is defined as pain lasting longer than 3-6 months and can be nociceptive, neuropathic, or mixed in nature. Chronic pain is best managed using a multidisciplinary approach including pharmacological interventions like opioids, antidepressants, anticonvulsants, as well as non-pharmacological therapies like cognitive behavioral therapy, physical therapy, and interventional procedures. The goals of chronic pain management are to improve function and quality of life, rather than to cure the underlying cause of pain.
This document discusses pain management in cardiac surgery. It begins with an overview of pain and its assessment, including different scales used to measure pain intensity. It then discusses factors that can cause pain after cardiac surgery, including sternotomy sites and chest tube insertion. Effective pain management is important for patient outcomes and recovery. The document reviews the pain pathway and different approaches to treating pain, including opioids, regional techniques, and multimodal analgesia. It provides details on specific opioids like morphine, fentanyl, and sufentanil that are commonly used in cardiac surgery.
Gabapentin reduced acute pain after mastectomy and decreased the incidence of chronic pain in two studies. A single dose of gabapentin was ineffective for reducing thoracotomy pain when an epidural was also used. Regional anesthesia and intravenous lidocaine reduced chronic pain incidence after mastectomy or thoracotomy in several studies. Ketamine and intercostal cryoanalgesia did not reduce chronic pain. Total intravenous anesthesia may reduce post-thoracotomy pain in one study.
The document summarizes a study comparing the effectiveness of triple acupuncture therapy versus carbamazepine treatment for primary trigeminal neuralgia. Sixty-four patients were randomly assigned to receive either triple acupuncture at trigger points or oral carbamazepine for one month. Results showed the acupuncture group had significantly higher pain relief rates and lower pain scores than the carbamazepine group at follow-up. Adverse effects were also less common with acupuncture. The study concludes that triple acupuncture may be a safer and more effective alternative to carbamazepine for trigeminal neuralgia.
Pain results from a variety of pathological processes and is considered as a vital sign.
It is expressed differently by each patient depending on cultural background, age, etc,etc.
IT IS A HIGHLY SUBJECTIVE EXPERIENCE MEANING THAT ONLY THE INDIVIDUAL IS ABLE TO ASSESS HIS/HER LEVEL OF PAIN.....
This document provides guidance on clinical development of new pain medications. It discusses general considerations like pharmacokinetic and dose response studies. It recommends study designs for exploring efficacy in acute and chronic pain, including appropriate patient populations, endpoints, and trial duration. Safety evaluation over long term use is also addressed. Special populations like children, elderly, and those with renal or hepatic impairment require tailored study approaches.
The document discusses antidepressants in chronic pain relief. It provides background on chronic pain and classifies pain based on pathophysiology, duration, etiology, and anatomy. It then discusses the pathophysiology of nociceptive and neuropathic pain in detail. The document reviews various types of antidepressants and their mechanisms of action. It summarizes evidence from multiple studies that tricyclic antidepressants and selective serotonin reuptake inhibitors can effectively treat chronic pain conditions like diabetic neuropathy and post-herpetic neuralgia at doses lower than those used for depression. The antidepressants may relieve pain through mechanisms other than their antidepressant effects.
The document discusses pain management, including defining pain, different pain theories like the gate control theory, differentiating between acute and chronic pain, non-pharmacological and pharmacological interventions. It covers non-opioid analgesics, opioid analgesics according to pain level, opioid side effects, equianalgesic dosing, adjuvants, the WHO pain ladder, routes of opioid delivery, patient-controlled analgesia, and nursing guidelines for patient-centered pain management.
Postoperative pain is harmful and leads to both acute and chronic negative effects if poorly controlled. A multimodal approach to pain management is recommended, utilizing both pharmacological and non-pharmacological techniques. This includes the use of opioids, non-opioid analgesics like NSAIDs and gabapentinoids, and regional analgesic techniques such as epidurals, peripheral nerve blocks, and trigger point injections to provide superior pain relief with fewer side effects than systemic opioids alone. The goal is to control pain and facilitate early recovery after surgery.
The document discusses pain, including definitions of pain, types of pain (such as acute vs. chronic), consequences of pain, pain assessment scales, and approaches to pain management. It notes that pain management may involve pharmacological approaches like opioids, non-pharmacological approaches like physical therapy, and interventional procedures like spinal cord stimulators. The WHO analgesic ladder is also summarized, which recommends treating mild pain with non-opioids, moderate pain with mild opioids, and severe pain with strong opioids by the clock and by mouth until the patient is pain-free.
Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign.
This document provides an overview of pain, including its definition, classification, transmission pathways, and management. It begins with defining pain and discussing its incidence and epidemiology. Pain is then classified based on its source, duration, and transmission. The pathways of pain transmission from nociceptors to the central nervous system are explained. Finally, the document discusses pain assessment, management guidelines, and concludes with references.
Acute pain management & preemptive analgesia (3)DR SHADAB KAMAL
This document discusses acute pain management and pre-emptive analgesia. It defines acute pain as pain caused by actual or potential tissue damage that is usually nociceptive in nature. Acute pain management primarily deals with patients recovering from surgery or acute medical conditions. Pre-emptive analgesia aims to prevent central neural sensitization by administering analgesics before a painful stimulus occurs, which can reduce both acute postoperative pain and the risk of chronic postsurgical pain. The document outlines various treatment approaches for acute pain management, including opioids, non-opioid analgesics, regional anesthetic techniques, and multimodal analgesia.
1. Cancer pain affects a large percentage of cancer patients, with moderate to severe pain reported in over 33% of cases. Proper pain management is important to relieve unnecessary suffering and reduce further weakening of patients.
2. Cancer pain can be nociceptive (from tissue damage) or neuropathic (from nerve damage) in nature, with bone pain being very common. Treatment involves modifying the pathological process, elevating pain thresholds, interrupting pain pathways, and lifestyle modifications.
3. Effective cancer pain management requires a rational approach using the WHO guidelines, with an emphasis on relieving pain at all stages of disease through various pharmacological and non-pharmacological means.
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Microbial interaction
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Positive interaction: mutualism, proto-cooperation, commensalism
Negative interaction: Ammensalism (antagonism), parasitism, predation, competition
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i. Lichens:
Lichens are excellent example of mutualism.
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Compound A
Utilized by population 1
Compound B
Utilized by population 2
Compound C
utilized by both Population 1+2
Products
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We present the JWST discovery of SN 2023adsy, a transient object located in a host galaxy JADES-GS
+
53.13485
−
27.82088
with a host spectroscopic redshift of
2.903
±
0.007
. The transient was identified in deep James Webb Space Telescope (JWST)/NIRCam imaging from the JWST Advanced Deep Extragalactic Survey (JADES) program. Photometric and spectroscopic followup with NIRCam and NIRSpec, respectively, confirm the redshift and yield UV-NIR light-curve, NIR color, and spectroscopic information all consistent with a Type Ia classification. Despite its classification as a likely SN Ia, SN 2023adsy is both fairly red (
�
(
�
−
�
)
∼
0.9
) despite a host galaxy with low-extinction and has a high Ca II velocity (
19
,
000
±
2
,
000
km/s) compared to the general population of SNe Ia. While these characteristics are consistent with some Ca-rich SNe Ia, particularly SN 2016hnk, SN 2023adsy is intrinsically brighter than the low-
�
Ca-rich population. Although such an object is too red for any low-
�
cosmological sample, we apply a fiducial standardization approach to SN 2023adsy and find that the SN 2023adsy luminosity distance measurement is in excellent agreement (
≲
1
�
) with
Λ
CDM. Therefore unlike low-
�
Ca-rich SNe Ia, SN 2023adsy is standardizable and gives no indication that SN Ia standardized luminosities change significantly with redshift. A larger sample of distant SNe Ia is required to determine if SN Ia population characteristics at high-
�
truly diverge from their low-
�
counterparts, and to confirm that standardized luminosities nevertheless remain constant with redshift.
Pharmacist Educational Intervention in Intravenous Patient Controlled Analgesia is Associated with Decreased Postoperative Pain
1. Pharmacist Educational Intervention in
Intravenous Patient-controlled Analgesia is
Associated with Decreased Postoperative
Pain
Under the guidance of :
Miss. C. Anamika, M. Pharmacy
Department of : pharmacology
Presented by:
Sameena khatoon(13AD1R0052)
3. INTRODUCTION
Pain is a distressing feeling often caused by intense or damaging
stimuli, such as stubbing a toe, burning a finger, putting alcohol on
a cut. Because it is a complex, subjective phenomenon, defining
pain has been a challenge. The “International Association for the
Study of Pain’s” widely used definition states: "Pain is an
unpleasant sensory and emotional experience associated with actual
or potential tissue damage, or described in terms of such damage."
CLASSIFICATIONS:
Responding to the need for a more useful system for
describing chronic pain, the International Association for the Study
of Pain classified pain according to specific characteristics:
• Region of the body involved (e.g. abdomen, lower limbs),
• System whose dysfunction may be causing the pain (e.g., nervous,
gastrointestinal),
• Duration and pattern of occurrence,
• Intensity and time since onset, and
• Cause.
4. However, this system has been criticized by Clifford J Woolf and
others as inadequate for guiding research and treatment. Woolf
suggests three classes of pain:
• Nociceptive pain,
• Inflammatory pain which is associated with tissue damage and the
infiltration of immune cells, and
• Pathological pain which is a disease state caused by damage to the
nervous system or by its abnormal function (e.g. fibromyalgia,
peripheral neuropathy, tension type headache, etc.).
Chronic pain:
• Pain is usually transitory, lasting only until the noxious stimulus is
removed or the underlying damage or pathology has healed, but
some painful conditions, such as rheumatoid arthritis, peripheral
neuropathy, cancer and idiopathic pain, may persist for years. Pain
that lasts a long time is called chronic or persistent, and pain that
resolves quickly is called acute.
5. Nociceptive
• Nociceptive pain is caused by stimulation of sensory nerve
fibers that respond to stimuli approaching or exceeding harmful
intensity (nociceptors), and may be classified according to the mode
of noxious stimulation. The most common categories are "thermal"
(e.g. heat or cold), "mechanical" (e.g. crushing, tearing, shearing,
etc.) and "chemical" (e.g. iodine in a cut or chemicals released
during inflammation). Nociceptive pain may also be divided into
"visceral", "deep somatic" and "superficial somatic" pain.
Neuropathic pain
• Neuropathic pain is caused by damage or disease affecting any part of
the nervous system involved in bodily feelings (the somatosensory
system). Peripheral neuropathic pain is often described as "burning",
"tingling", "electrical", "stabbing", or "pins and needles".
Phantom pain
• Phantom pain is pain felt in a part of the body that has been lost or
from which the brain no longer receives signals. It is a type of
neuropathic pain.
6. Psychogenic pain
• Psychogenic pain, also called psychalgia or somatoform pain, is
pain caused, increased, or prolonged by mental, emotional, or
behavioral factors. Headache, back pain, and stomach pain are
sometimes diagnosed as psychogenic.
Breakthrough pain
• Breakthrough pain is transitory acute pain that comes on suddenly
and is not alleviated by the patient's regular pain management. It is
common in cancer patients who often have background pain that is
generally well-controlled by medications, but who also sometimes
experience bouts of severe pain that from time to time "breaks
through" the medication. The characteristics of breakthrough cancer
pain vary from person to person and according to the cause.
Management of breakthrough pain can entail intensive use
of opioids, including fentanyl.
Incident pain
• Incident pain is pain that arises as a result of activity, such as
movement of an arthritic joint, stretching a wound, etc.
7. Treating post-operative pain
• When choosing options for pain management after surgery,
healthcare professionals aim to use the most effective treatments
while keeping side effects to a minimum.
• These are some of the medicines and methods used for post-operative
pain control:
Opioids,
Non-steroidal anti-inflammatory drugs (NSAIDs),
Cyclooxygenase (COX)-2 inhibitors,
Patient-controlled analgesia (PCA),
Music therapy,
Other kinds of anesthesia.
8. AIM AND OBJECTIVE
This study was conducted to compare the
clinical efficacy and adverse effects of
multimodal analgesic regimen of
morphine and nalbuphine combined with
ketorolac using IV PCA, and to study the
effect of structured preoperative
educational program on analgesic
efficacy, incidence of adverse effects,
and patients` satisfaction.
9. LITERATURE REVIEW
Yi MS1, Kang H2, et al Relationship between the
incidence and risk factors of postoperative nausea and
vomiting in patients with intravenous patient-controlled
analgesia. This study aims to evaluate retrospectively the
electronic medical records of surgical patients who received
intravenous patient-controlled analgesia, to identify
potential relationships between the incidence and risk
factors of postoperative nausea and vomiting (PONV).
Records of 6773 adult patients who received fentanyl-based
intravenous patient-controlled analgesia after surgery at
Chung-Ang University Hospital between January 1, 2010
and December 31, 2015 were reviewed. Multiple logistic
regressions were used to identify risk factors for PONV.
10. As the incidence of PONV was 2.8%, 6.0%, 11.7%, 15.2%,
21.1%, 50.0%, and 100% for patients who had 0, 1, 2, 3, 4, 5,
and all these risk factors, respectively, risk-adapted,
multimodal, or combination therapy should be applied for
patients receiving general anesthesia.
Despite the use of antiemetic prophylaxis, 18.0% of patients
with intravenous patient-controlled analgesia had PONV. Use
of desflurane and nitrous oxide, in addition to risk factors
included in the Apfel score (female gender, nonsmoking
status, history of PONV or motion sickness, and use
of postoperative opioids) were identified as independent risk
factors.
11. Komasawa N1 et al Effects of stylet use during tracheal
intubation on postoperative pharyngeal pain in
anesthetized patients: A prospective randomized
controlled trial. This study aimed to compare the impact of
stylet application for tracheal intubation
for postoperative pharyngeal pain or hoarseness in patients
undergoing elective surgery. Randomized clinical trial.
Tracheal intubation was performed by anesthesiologists with
stylet group (Stylet group; 20 patients) or without stylet group
(Control group; 20 patients). Incidence
of postoperative pharyngeal pain or hoarseness was assessed.
The incidence of postoperative pharyngeal pain was
significantly higher in the Stylet group (10/20 patients) than
in the Control group (2/20 patients) (P=0.013). The incidence
of hoarseness did not significantly differ between the Stylet
group (6/20 patients) and the Control group (3/20 patients)
(P=0.45).
12. MATERIALS AND METHODS
Patient Selection:
• The study was, after full history taking, physical examination and
complete investigations, from those patients who were admitted for
different types of surgical procedures. The local ethics committees
approved the protocol, and informed consent was obtained from all
patients before study entry. Recruitment included patients with
physical status of an American Society of Anesthesiologists (ASA) I
and II, aged between 33 - 68 years. Exclusion criteria included:
history of allergy to the study drugs, contraindication to the study
drugs, refuse of using PCA as a pain management method, history of
hepatic, cardiopulmonary or renal disease, hemodynamic instability,
history of any chronic pain or drug history of analgesics,
administration of opioid in the last 4 hours, history of substance abuse
and psychiatric disorder.
13. Study Design:
• The study was prospective randomized double blinded, in which
patients were randomized either to receive morphine for
postoperative analgesia using PCA disposable infusion device (group
M), or receive PCA nalbuphine for postoperative analgesia (group
N). The study was double blinded using opaque sealed envelope;
both patients and the anesthesiologists managing postoperative pain
were blinded to knowledge of the group to which they belonged.
Patients were selected randomly from either morphine or nalbuphine
group to attend additional structured preoperative educational
program provided by the pharmacist. Accordingly, patients in
morphine group were randomly sub classified into either morphine
control group (group M1) or morphine intervention group (group
M2); both groups received the usual hospital routine care for pain
management. Similarly patients in nalbuphine group were randomly
sub classified into either nalbuphine control group (group N1) or
nalbuphine intervention group (group N2); both groups received the
usual hospital routine care for pain management.
14. Postoperative Assessment:
Primary Outcomes:
The primary outcomes measured postoperatively were pain intensity
using Blood Pressure (BP), respiratory rate(RR), heart rate(HR).
Assessment was carried out at zero time and every 1/2 hour for the first 4
hours then every 2 hours till the end of the second postoperative day.
Secondary Outcomes:
The secondary outcomes included level of sedation using the Ramsey
Sedation Scale and total cumulative opioid doses. Incidences and
severity of adverse effects and patient satisfaction were assessed. Arterial
blood sample was taken at 0, 12, 14, 36, 48 postoperative hours to assess
partial pressure of carbon dioxide (PaCO2), and oxygen saturation.
Statistical Analysis:
The SPSS version 22 software and Microsoft office excel 2010 were
used for statistical analysis. Results are presented as means ± standard
deviations (SD) for continuous data, median and range for ordinal data,
and as frequencies and percentages for categorical data.
15. DRUG PROFILE
CONTENTS MORPHINE NALBUPHINE KETOROLAC
CHEMICAL
FORMULA
C17H19NO3 C21H27NO4 C15H13NO3
MOLECULAR
WEIGHT
285.34 g/mol 357.443g/mol 255.273g/mol
STRUCTURE
16. BIOAVAILABILIT
Y
PROTIEN
BINDING
METABOLITES
HALF LIFE
DURATION OF
ACTION
EXCRETION
20-30% by
mouth,36-71% by
rectally, 100% by
Intravenous and
intra muscular
30-40%
Hepatic
2-3 hours
3-7 hours
Renal 90%, biliary
10%
76%-81% by
intramuscular
>50%
Hepatic
3-5 hours
5-10 hours
93% by renal
30-40% by
intramuscular
>50%
Hepatic
4-5 hours
7-9 hours
92% by renal, 6%
by faeces
MECHANISM OF
ACTION
It binds to mu
receptor and shows
its pharmacological
effect
It binds kappa
receptor and shows
its action
Inhibits the
prostaglandin
synthesis by
blocking of enzyme
cox
USES Analgesic Analgesic Analgesic,
antipyretic
20. RESULTS
Patient Enrollment and Baseline Characteristics a total of 60 patients
were enrolled and screened to be eligible for the study according to
the inclusion and exclusion criteria.
1. The two drug groups were comparable with respect to sex, age,
weight, ASA, drug history and type of surgery.
PARAMETERS Group M Group N P value
SEX 9/13 12/11 0.45
AGE 51.4±11.6 47.6±11.7 0.36
WEIGHT 61.2±7.4 63.7±10.0 0.35
ASA physical status classification 12/10 12/11 0.61
22. Drug History:
Beta- blocker
Ca++ channel blocker
Diuretics
Oral hypoglycemic and insulin
Beta-2 agonist
2
1
5
6
1
3
2
3
5
0
0.80
1.00
0.40
0.73
0.30
Opioid Requirement:
Postoperative results revealed a statistically significant higher
cumulative opioid doses consumption for patients in group N
compared with those in group M (as morphine equivalents; on basis
of that 1mg nalbuphine=0.7 mg morphine). On the other hand,
numbers of patients that required additional analgesic doses
(additional dose of the study opioid drug) were not statistically
different in the two drug groups (P: 0.37)
23. Parameters Group M Group N P value
Cumulative opioid doses 68.6±6.2 92.2±6.8 <0.01
Number of patients received
additional analgesia
17 15 0.37
Incidence and
severity of adverse
effects
Group M Group N P value
Nausea 0(0-4) 0(0-2) 0.22
Drowsiness 0(0-2) 0(0-2) 0.68
Itching 0(0-2) 0(0-2) 0.03
Dizziness 0(0-2) 0(0-2) 0.27
Incidence and Severity of Adverse Effects
Regarding incidence and severity of adverse effect postoperatively,
ranged from 0 no itching to 10 severe itching, was lower in group N
than group M (P: 0.03*). Incidences of postoperative nausea,
drowsiness, dizziness were not statistically different in the two drug.
24. Patient satisfaction with pain management Median score of the least
pain in the first 24 postoperative hours was significantly lower in
group M than in group N (P<0.01*) as shown in Table 6. Also patients
in group N experienced a significantly higher percentage of time
experience of severe pain during the first 24 hours than those patients
in group M (P: 0.02*). While other scores of satisfaction were similar
between morphine and nalbuphine group.
25. DISCUSSION
Postoperative pain is a major problem, for health care
professionals, which requires intense workup for
effective management. Postoperative pain control
decreases morbidity, facilitates rapid recovery and
reduces hospital length of stay. Opioids are commonly
used for postoperative pain control; however, nausea,
vomiting, pruritus, constipation, and respiratory
depression are major associated drawbacks. So pain
control should be balanced against these adverse
effects. PCA is commonly used postoperatively to
manage pain, however little is known about PCA
itself. Patient may neglect pain and avoid activation of
PCA due to fear of addiction from opioids or
occurrence of adverse effects when use it frequently.
26. Morphine is an opioid that produces analgesia through acting
on mu receptors. The many adverse effects of morphine are
related to mu receptor binding. Nalbuphine, on the other hand,
acts as an agonist on kappa receptors which provides analgesia
and as an antagonist on mu receptor. Nalbuphine has a ceiling
effect in its respiratory depression and is considered to be
safer than morphine with minimum incidence of postoperative
pruritus, nausea and vomiting. The analgesic effect of
nalbuphine through kappa receptors reaches a ceiling effect.
This can lead to unpredictable analgesic efficacy for surgical
procedures. So the analgesic efficacy depends on its complex
pharmacodynamics profile rather than pharmacokinetic. Results
of comparative studies between morphine and nalbuphine are
inconsistent. There is no evidence to indicate which is better for
pain control.
27. The present study was performed to compare the clinical
efficacy and adverse effects of PCA morphine and nalbuphine
combined with ketorolac in postoperative setting and evaluate
the effectiveness of a constructed educational program for pain
management on patients `outcomes. To accomplish the goal, a
combination of opioid analgesics, either morphine (morphine
group) or nalbuphine (nalbuphine group), and non-opioid
analgesic ketorolac was used for PCA administration. Groups
were subdivided into control and intervention groups. Patient
and nurse education on safe and effective use of PCA was
provided to the intervention groups.
Thus the structured preoperative educational program has a
positive impact attitude toward self-administration of analgesics,
better pain control and satisfaction with pain management using
PCA.
28. CONCLUSION
Morphine provides more effective postoperative analgesia than
nalbuphine when administered with ketorolac. The combination
of ketorolac allowed more pronounced synergistic effect with
morphine than that with nalbuphine. Preoperative patient and
nurse education improved analgesia and overall patient
satisfaction with their pain treatment protocol; the patient can
treat pain more in a more timely and individualized manner, thus,
increasing pain-management satisfaction. Preoperative PCA
education avoids patient’s confusion between PCA button and the
nurse call button, allows patients to be familiar with PCA
technique and reduces fear of addiction from frequent use of
PCA. Also education may allow patients to balance between
administration of analgesics and adverse events by self-adjusting
the dose of analgesic used. Limitation of the study: Pain intensity
is not estimated during rest and at movement/coughing which is
important to judge the analgesic efficacy.
29. Dickerson DM. Acute pain management. Anesthesiol
Clin. 2014;32;495-504.
Prabhakar A, et al. Preoperative analgesia outcomes
and strategies. Best Pract Res Clin Anesthesiol.
2014;28:105-115.
Licht E, et al. Can the cognitively impaired safely use
patient-controlled analgesia?. J Opioid Manang.
2009;5:307-312
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