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PACUs ANALGESIAPACUs ANALGESIA
DR . FATMA ALDAMMASDR . FATMA ALDAMMAS
PAINPAIN
• 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 ANALGESIAPACUs ANALGESIA
Postoperative pain differs from other types of pain
PACUs ANALGESIAPACUs ANALGESIA
CAUSES OF VARIATION IN ANALGESIC REQUIREMENTS
• Site and type of surgery• Age, gender and body weight• Psychological factors • Pharmacokinetic variability• Pharmacodynamic variability
PACUs ANALGESIAPACUs 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 ANALGESIAPACUs ANALGESIA
PACUs ANALGESIAPACUs 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 ANALGESIAPACUs 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 ANALGESIAPACUs ANALGESIA
PACUs ANALGESIAPACUs ANALGESIA
Pharmacokinetic variability
PACUs ANALGESIAPACUs ANALGESIA
• Pharmacodynamic variability
PACUs ANALGESIAPACUs ANALGESIA
Methods of treating pain in PACUsMethods of treating pain in PACUs
Methods of treating pain in PACUsMethods of treating pain in PACUs
Methods of treating pain in PACUsMethods of treating pain in PACUs
Methods of treating painMethods of treating painin PACUsin 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 CYCLEI.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 Relationship of mode of delivery of analgesia to serum analgesic levelserum analgesic level
• IM and IV PCA
Methods of treating painMethods of treating painin PACUsin PACUs
Methods of treating painMethods of treating painin PACUsin PACUs
Methods of treating painMethods of treating painin PACUsin PACUs
ALGORITHMS FOR OPIOID ADMINISTRATION
Methods of treating painMethods of treating painin PACUsin 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 painMethods of treating painin PACUsin 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 painMethods of treating painin PACUsin PACUs
PARENTERAL ROUTES OF OPIOID ADMINISTRATION
• Bolus i.v. administration• Continuous i.v. infusion• PCA
MethodsMethods of treating painof treating painin PACUsin PACUs
PCAPCA
• 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 Relationship of mode of delivery of analgesia to serum analgesic levelserum analgesic level
• IM and IV PCA
Methods of treating painMethods of treating painin PACUsin PACUs
PARENTERAL ROUTES OF OPIOID ADMINISTRATION
patient-controlled analgesia (PCA)•
Methods of treating painMethods of treating painin PACUsin 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 painMethods of treating painin PACUsin PACUs