Postoperative pain

Another clinical consideration is the abiUty of local anesthetic agents to effect differential blockade of sensory and motor fibers. In surgical procedures such as obstetrics or postoperative pain rehef, an agent which produces profound sensory block accompanied by minimal motor block is desirable. On the other hand some procedures such as limb surgery require both deep sensory and motor blockade. In clinical practice, bupivacaine ( 22,... 

Anesthesia Anesthesia is a loss of sensation or feeling. Anesthesia (or "anesthetics") is often used deliberately by doctors and dentists to block pain and other sensations during surgical procedures. Treatment for pre- or postoperative pain is called analgesia. 

Basically there are three types of pain acute pain, chronic pain associated with malignant disease, and chronic pain not associated with malignant disease Acute pain is of short duration and lasts less than 3 to 6 months. Intensity of acute pain is from mild to severe Causes of acute pain include postoperative pain, procedural pain, and traumatic pain. Acute pain usually subsides when the injury heals. 

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. 

Roger Baccus, age 23 years, is prescribed Demerol for postoperative pain. You discover in his health history on the chart that he has a history of alcohol and drug use. Determine what further assessments you would need to make Explain how Roger s answers would influence the actions that you as a nurse would take. 

Cross A, Asher L, Seguin M, Yuan L, Kelly N, Hammack C (1995) The importance of a hpopoly-sacchaiide-initiated, cytokine-mediated host defense mechanism in mice against extraintesti-nally invasive escheiichia coh. J Clin Invest 96(2) 676-686 Dahan A, van Dorp E, Smith T, Yassen A (2008) Morphine-6-glucuronide (M6G) for postoperative pain relief. Eur J Pain 12(4) 403-411... 

G. Gourlay and R. Boas, Fatal outcome with use of rectal morphine for postoperative pain control in an infant, Br. Med. J, 304, 766 (1992). 

Pain intensity, pain relief, and medication side effects must be assessed on a regular basis. The timing and regularity of assessment depend on the type of pain and the medications administered. Postoperative pain and acute exacerbations of cancer pain may require hourly assessment, whereas chronic nonmalignant pain may need only daily (or less frequent) monitoring. 

A study on racial differences in receipt of analgesics found that nearly three-fourths (74%) of white patients compared with 57% of African American patients received analgesics for lower extremity fractures in emergency departments (Todd et al., 2001). An assessment of racial/ethnic differences in physicians prescriptions of patient-controlled analgesia for postoperative pain found that after adjustment for age, gender, preoperative... 

At the sensitive extreme are those who experience pain of an acute nature even when the stimulus is only moderate. Those hypersensitive individuals are perhaps those for whom even suggestion may cause pain and who exhibit referred pain in a most striking manner. A recent observation would make it appear likely that hyposensitive, average and hypersensitive individuals are about equal in number. Papper, et al., 14 state that only about one-third of a group of 286 unselected patients complained of severe postoperative pain, one-third had moderate pain, and one-third no pain at all. 

Gilron, I., Max, M.B., Lee, G., Booher, S.L., Sang, C.N., Chappell, A.S., and Dionne, R.A., Effects of the 2-amino-3-hydroxy-5-methyl-4-isoxazole-proprionic acid/kainate antagonist LY293558 on spontaneous and evoked postoperative pain, Clin. Pharmacol. Ther., 68, 320, 2000. 

These analgesics are chiefly used for the relief of postoperative pain, cardiac pain and pains of terminal cancer, and in child birth. 

Xen-2174 (220) (isolated from the snail Conus marmoreus) 13-Amino-acid peptide (a conotoxin) Xen-2174 (220) Neurology (Pain) Inhibits norepinephrine transporter (NET) Phase II (against acute postoperative pain and chronic pain in cancer patient) Xenome 970-973... 

Dahan A, van Dorp E, Smith T, Yassen A. (2008) Morphine-6-glucuronide (M6G) for postoperative pain relief. Eur J Pain 12 403 11. 

One study has described the use of NSAID-loaded liposomes for the targeting of inflammatory lesion sites for the treatment of postoperative pain and pain related to various types of cancer [186]. In this study they showed strong and immediate analgesic effects in relieving pain with NSAID-loaded liposomes, but did not compare this with the analgesic effects of free NS AID. 

Adverse reactions occurring in at least 3% of patients include nausea vomiting tachycardia hypertension postoperative pain fever dizziness. 

Promethazine Promethazine also is indicated for preoperative, postoperative, or obstetric sedation prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery an adjunct to analgesics for control of postoperative pain sedation and relief of apprehension, and to produce light sleep antiemetic effect in postoperative patients active and prophylactic treatment of motion sickness (oral and rectal only). 

IV Relief of severe pain pain of Ml used preoperatively to sedate the patient and allay apprehension, facilitate anesthesia induction, and reduce anesthetic dosage control postoperative pain relieve anxiety and reduce left ventricular work by reducing preload pressure treatment of dyspnea associated with acute left ventricular failure and pulmonary edema produce anesthesia for open-heart surgery. 

Subcutaneous/IM Relief of severe pain relieve preoperative apprehension preoperative sedation control postoperative pain supplement to anesthesia analgesia during labor acute pulmonary edema allay anxiety. 

Not indicated for pain in the immediate postoperative period (the first 12 to 24 hours following surgery), or if the pain is mild or not expected to persist for an extended period of time. Oxycodone controlled-release tablets are only indicated for postoperative use if the patient is already receiving the drug prior to surgery or if the postoperative pain is expected to be moderate to severe and persist for an extended period of time. Individualize treatment, moving from parenteral to oral analgesics as appropriate. 

Total low dose 2 meg/kg in small doses for minor, painful surgical procedures and postoperative pain relief. 

Transmucosal- Management of acute or postoperative pain opioid nontolerant patients. 

Nalorphine and levallorphan are examples. For example in patients with postoperative pain the analgesic effects of 10 mg of nalorphine is about the same as 10 mg of morphine. On the other hand naloxone and naltrexone seem to have no agonistic activity and some antagonistic affinity for all types of opioid receptors. Although antagonists could be expected to have effects by altering the actions of endogenous opioid peptides mostly such effects are not discernable. 

Apart from their anti-inflammatory activity the NSAIDs also show, dependent on the condition and the type of pain, considerable analgesic efficacy. In some forms of postoperative pain the NSAID s can be as efficacious as opioids, especially when prostaglandins, bradykinin and histamine, which are released by inflammation, have caused sensitization of pain receptors to normally painless stimuli. In Table 4 some advantages and disadvantages of NSAID s and opioids are compared. Although analgesic effects at peripheral or central neurons cannot be excluded completely, most studies indicate that... 

Roytblat L, Korotkoruchko A, Katz J, et al (1993) Postoperative pain the effect of low-dose ketamine in addition to general anesthesia. Anesth Analg 77 1161-1165 Rzeski W, Turski L, Ikonomidou C (2001) Glutamate antagonists limit tumor growth. Proc Natl Acad Sci USA 98 6372-6377... 

Schmid RL, Sandler AN, Katz J (1999) Use and efficacy of low-dose ketamine in the management of acute postoperative pain a review of current techniques and outcomes. Pain 82 111-125... 

Ketorolac (Toradol) is an NS AID with very mild antiinflammatory and antipyretic activity. It is a potent analgesic for postoperative pain. Its efficacy is equivalent to that of low doses of morphine in the control of pain. For this reason it is often combined with opioids to reduce opioid dose and related side effects while providing adequate pain relief. It is also used to replace the opioids in some patients with opioid sensitivity. The mechanism of action of ketorolac involves the inhibition of COX and decreased formation of prostaglandins. However, some evidence exists that ketorolac may stimulate the release of endogenous opioids as a part of its analgesic activity. 

Sharpe, D. G. Lambert, and D. L. Rowbotham. Lack of analgesic efficacy of oral delta-9-tetrahydrocannabinol in postoperative pain. Pain 2003 CS336... 

Postoperative pain Lorazepam 0.25 mg qSh IV Post-salpingo-oophorectomry Given alernating with small dose of burpenorphine Richtsmeier et al., 1992... 

Related to codeine, dihydrocodeine is a rather weak analgesic, usually combined with other drugs and used as a headache suppressant, ft is often, however, prescribed for postoperative pain, dyspnea, and as an antitussive. Dihydrocodeine is twice as potent as codeine. 

Adverse effects include laryngospasm, which occurs generally when respiratory secretions or other irritants are present. Shivering and delirium may occur during recovery. Postoperative pain induces restlessness. Nausea and vomiting are uncommon. It can precipitate acute intermittent porphyria in susceptible individuals. 

To relieve preoperative and postoperative pain or to supplement the analgesic action of anaesthetics. 

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