Post operative Pain and Regional Anaesthesia

1
Post operative Pain and Regional Anaesthesia

• Dr Maya Nagaratnam FFPMRCA FRCA

2
Learning Objectives

• List 6 important reasons for post operative pain
  control
• Choose appropriate analgesic regimes
• Know when to call for senior advice

3
Why is it important to control pain?

• Divinum sedare dolorem
• Reduce Sympathetic activity ( ACS)
• Reduce respiratory complications
• Reduced chronic pain syndromes
• Improved mobilisation
• Improved patient satisfaction

4
Divinum sedare dolorem
5
Reduce respiratory complications
6
Reduce Sympathetic activity ( ACS)
7
Improved mobilisation
8
Reduce Chronic Pain Syndromes
9
Improved patient satisfaction
10
Case 1

• It is your first on call as a Gas person.
• Bleeped about Mrs X
• DSU laproscopic cholesystectomy
• admitted overnight for uncontrolled pain.
• PONV

11
Put the following in the right order

• A. d/w Spr
• B. management plan
• C. history and pain assessment
• D. check notes, anaesthetic and drug charts

12
D, C, B ,A

• D. check notes, anaesthetic and drug charts
• C. history and pain assessment
• B. management plan
• A. d/w Spr

13
Pain Assessment
14
Management Options

• A. regular oral analgesia eg paracetamol,
  diclofenac, prn Im morphine
• B. regular IV paracetamol, prn IM morph, IVF,
  antiemetic
• C. morphine PCA
• D.Immediate IV morphine 0.5-1mg/kg titrate in 2mg
  aliquots
• E. C D IVF antiemetic.

15
WHO analgesic ladder....1, 2, 3
16
Analgesia

• Simple(mild)
• Paracetamol
• NSAIDs

• Moderate
• Codeine
• Tramadol

• Strong
• Fentanyl
• Morphine

Adjuvants ketamine, gabapentin
17
General points

• Ladder -Breakthrough pain - strong analgesics as
  per WHO pain ladder
• Oral -Regular oral analgesia ASAP
• Others -Treat co existing symptoms fluids,
  antiemetic, laxatives , oxygen

18
CASE 2

• 57 y old 3d post laporotomy, thoracic epidural,
  can take free fluids
• Excruciating pain last 2 h

• A. Morphine PCA
• B. Notes, drug chart
• C. D/W SpR
• D. Hx, examination ( epidural site)
• E. Regular oral analgesia, breakthrough morphine
• F.Bolus/ top up

19
B, D, F, E, A, C

• B. Notes, drug chart
• D. Hx, examination ( epidural site)
• F. Bolus/ top up
• E. Regular oral analgesia, breakthrough morphine
• A. Morphine PCA
• C. D/W SpR

20
Regional analgesia

• Peripheral nerve block
• Mainly extremeties, particularly ortho
• Epidural
• Used as both analgesia and anaesthetic, usually
  catheter in situ can top up
• Spinal
• Similar to epidural , but lower concentrations
  required, rarely catheter in situ, continuous
  prolonged analgesia not appropriate

21
Peripheral Nerve Block
22
Spinal (A) v Epidural (B)
23
Summary control of POP
24
General concepts pain treatment

• L
• O
• O

25
General concepts pain treatment

• L (ladder) WHO pain ladder stepwise
  increment of strength of analgesia start at
  appropriate level
• O (oral) establish oral analgesics ASAP
• O (other assoc. symptoms ) Treat N, V,
  dehydration, constipation, anxiety.

26
(No Transcript)
27
Learning Objectives

• List 6 important reasons for post operative pain
  control
• Choose appropriate analgesic regimes
• Know when to call for senior advice

28
(No Transcript)