Pain management postoperative

This type of pain management is used for postoperative pain, labor pain, and cancer pain. The most serious adverse reaction associated with the administration of narcotics by the epidural route is respiratory depression. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. Fentanyl is increasingly used as an alternative to morphine sulfate because patients experience fewer adverse reactions. 

Ms. Taylor is receiving meperidine for postoperative pain management. In assessing Ms. Taylor approximately 20 minutes after receiving an injection of meperidine, the nurse discovers Ms. Taylor s vital signs are blood pressure 100150 mm Hg, pulse rate 100 bpm, and respiratory rate 10 /min. Determine what action, if any, the nurse should take. 

Clinical use The indications for levobupivacaine include wound infiltration (0.25 % solution), nerve conduction block (0.25 - 0.5 %), spinal analgesia (0.5 %) and epidural anesthesia (0.5 to 0.75 %). For labour analgesia, lower concentrations of levobupivacaine are recommended when administered as epidural injection (0.125 to 0.25 % up to 25 mg) or infusion (0.25 %). The maximum dose for ilioinguinal or iliohypogastric block in children is 1.25 mg/kg/side (0.25 to 0.5 % solutions). For postoperative pain management, levobupivacaine can be applied epidurally in combination with the opioids fentanyl or morphine or with the a2-agonist clonidine. 

Consistent with these hypotheses is the finding that continuous infusion of the opioid into the epidural or intrathecal space provides optimal pain relief postoper-atively or in chronic, intractable pain.2 40 83 Continuous infusion is associated with certain side effects, especially nausea and constipation, as well as the potential for disruption of the drug delivery system.24 57 77 Problems with tolerance have also been reported during continuous administration,27 but it is somewhat controversial whether tolerance really develops when these drugs are used appropriately in the clinical management of pain (see section on Concepts of Addiction, Tolerance, and Physical Dependence ). Hence, the benefit-to-risk ratio for continuous epidural or intrathecal infusion is often acceptable in patients with severe pain. This method of opioid administration continues to gain acceptance.24 57... 

Brown AK, Christo PJ, Wu CL. Strategies for postoperative pain management. Best Pract Res Clin Anaesthesi-ol. 2004 18 703-717. 

Gajraj NM, Joshi GP. Role of cyclooxygenase-2 inhibitors in postoperative pain management. Anesthe-siol Clin North America. 2005 23 49-72. 

ChellyJE. An iontophoretic, fentanyl HC1 patient-controlled transdermal system for acute postoperative pain management. Expert Opin Pharmacother. 2005 6 1205-1214. 

Koo PJ. Postoperative pain management with a patient-controlled transdermal delivery system for fentanyl. Am J Health Syst Pharm. 2 00 5 62 1171-1176. 

Holder KA, Dougherty TB, Chiang JS. Postoperative pain management. Cancer Bull 1995 47 43-51. 

Miaskowski, C. (2005), Patient-controlled modalities for acute postoperative pain management, J. Perianesth. Nurs., 20(4), 255-267. 

Glass NL. Pediatric postoperative pain management. Anesth Analg 1998 (suppl) 28-31. 

Wu CT, Yu JC, Liu ST, Yeh CC, Li CY, Wong CS. Preincisional dextromethorphan treatment for postoperative pain management after upper abdominal surgery. World J Surg 2000 24(5) 512-17. 

Transdermal fentanyl avoids the discomfort of injections and reduces fluctuations in drug concentrations. In an open study of transdermal fentanyl patches 50 pg for postoperative pain management in 15 thoracotomy patients, two patients had nausea and one had erythema over the site of apphcation of the patch (55). 

Caplan RA, Ready LB, Oden RV, Matsen FA 3rd, Nessly ML, Olsson GL. Transdermal fentanyl for postoperative pain management. A double-blind placebo study. JAMA 1989 261(7) 1036-9. 

There have been several reports of impaired renal function in patients taking ketorolac (SEDA-17, 112) (SEDA-18, 105) (SEDA-22, 117). The severity varies from slight to severe forms of renal insufficiency, which may even occur after a single dose of 30 mg. Because recent major surgery is considered a risk factor for renal insufficiency, particularly in elderly patients, the use of ketorolac, or other NSAIDs, for postoperative pain management is warranted only in carefully selected patients. Furthermore, a case report confirmed that oral ketorolac can cause acute renal insufficiency in young subjects without any predisposing factors (SEDA-21,106). 

Standi TG, Horn E, Luckmann M, Burmeister M, Wilhelm S, Schulte am Esch J. Subarachnoid sufentanil for early postoperative pain management in orthopedic patients a placebo-controUed, double-bhnd study using spinal microcatheters. Anesthesiology 2001 94(2) 230-8. 

Use Provides symptomatic relief of allergic symptoms sedative/ antiemetic in surgery/labor decreases postop nausea/ vomiting adjunct to analgesics in control of pain management of motion sickness. Half-life UK minutes IM 20 minutes Rectal 20 minutes IV 3-5 minutes Onset PO 20 Peaks Duration 1-4 hours PO/IM Rectal/TV 2-8 hours... 

Indications Regional anesthesia for surgery, postoperative pain management... 

Gajraj NM. COX-2 inhibitors celecoxib and parecoxib valuable options for postoperative pain management. Curr Top Med Chem 2007 7 235-49. 

Cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central nervous system that limit their use. Their widespread introduction into clinical practice for pain management is therefore undesirable. In acute postoperative pain they should not be used. Before cannabinoids can be considered for treating spasticity and neuropathic pain, further valid randomised controlled studies are needed. 

The choice of an agent for use as an antipyretic or analgesic is seldom a problem. Drugs with more rapid onset of action and shorter duration of action probably are preferable for simple fevers accompanying minor viral illnesses or pain after minor musculoskeletal injuries, whereas a longer duration of action may be preferable for postoperative pain management. Sometimes a loading dose of such NSAIDs may be required. 

Ketorolac exerts typical NSAID effects. It prolongs the bleeding time and can impair renal function, especially in a patient with preexisting renal disease. Ketorolac is not available over-the-counter. Its piimaiy use is as a parenteral agent for pain management, especially for treatment of postoperative patients. The answer is (D). 

Mentes O, Bagci M. Postoperative pain management after inguinal hernia repair lornoxicam versus tramadol. Hernia 2009 13 427-30. 

White PR Subcutaneous-PCA an alternative to IV-PCA for postoperative pain management. 

Viscusi ER. Liposomal drug delivery for postoperative pain management (translational vignette). Reg Anesth Pain Med 2005 30(5) 491-496. 

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