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Acute Pain Management Lecture
Acute Pain Management
33
Medical
Professional
09/01/2012

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Term
Time limited pain elicited by injury of body tissues and activation of nociceptive transducers that remits when underlying pathology resolves.
Definition
Acute pain
Term
Give 3 classifications of pain with respect to duration of pain.
Definition
Severe acute phase - 3 to 5 days
Sub acute - 1 to 4 weeks
Chronic pain - 3 months or more
Term
Important objective finding of acute pain involving abdominal or thoracic regions.
Definition
Impaired ventilation
Term
5 options for treatment of acute pain.
Definition
Opioids
Local anesthetics
NSAIDS
Acetaminophen
Tramadol
Term
2 agents that modulate central processing of pain signal in the brain.
Definition
Opioids
Alpha 2 agonists
Term
3 agents that work at the dorsal horn to block the pain signal.
Definition
Local anesthetics
Opioids
Alpha 2 agonists
Term
Agents that works at the peripheral nerve to block nociceptive transmission of pain.
Definition
Local anesthetics
Term
2 agents that work at the level of the tissue trauma to block nociceptive transmission of pain.
Definition
Anti-inflammatory drugs
Local anesthetics
Term
2 alkaloid types of opioids.
Definition
Phenantherenes
Benzylisoquinolones
Term
Antagonist of mu receptors that undoes opioids effect.
Definition
Naloxone
Term
Delta agonists. What do delta receptors do?
Definition
Enkephalins. Modulates mu activity.
Term
Kappa receptor agonists.
Definition
Dynorphins
Term
Common protocol for use of opioids.
Definition
Initial bolus loading dose
PCA (Patient controlled analgesia)
Term
Opioid that should not be used for PCA.
Definition
Meperidine. Because it causes seizures (?)
Term
Morphine onset of action
Definition
IV <1 min
IM 1-5 min
PO 15-60 min
Term
Morphine dosing.
Definition
2 mg IV every 5 minutes until max dose 10-20 mg or comfort
PCA: 1-2mg every 8 minutes
Term
This opioid has no active metabolites and is safe to use in renal failure.
Definition
Hydromorphone. 5-8 times more potent than morphine.
Term
Hydromorphone dosing
Definition
0.1-0.2 mg q5min till max 1-2mg
PCA: 0.1-0.2 mg q8min
Term
Fentanyl's relative potency to morphine.
Definition
75-100 X's more potent
Term
Fentanyl dosing.
Definition
Acute post op: 25-50 ug q5min
PCA: 10-25 ug q8min
Term
Morphine has active metabolites which can accumulate in _____.
Definition
renal failure
Term
Causes delirium, seizures, myoclonus. Especially in renal failure patients or on patients receiving for more than 3 days.
Definition
Meperidine
Term
3 most common opioid side effects.
Definition
Nausea
Vomiting
Pruritis
Term
2 routes of delivery of local anesthetics.
Definition
Neuraxial - intrathecal or epidural
Regional nerve blockade
Term
Dilaudid is ....
Definition
hydromorphone
Term
Vicodin is...
Definition
Acetaminophen and hydromorphone
Term
Oxycontin is...
Definition
oxycodone.
Term
Percocet is...
Definition
oxycodone and paracetamol
Term
Paracetamol is essentially synonymous with...
Definition
acetaminophen.
Term
Arrange these in order of rate of absorption of local anesthetics, fastest to slowest.
Epidural, intercostal, sciatic, femoral, brachial plexus, caudal
Definition
Intercostal > Caudal > Epidural > Brachial Plexus > Sciatic/Femoral
Term
Demerol is...
Definition
meperidine.
Term
Toradol is...
Definition
ketorolac.
Term
How are the side effect profiles of COX-2 selective and non-selective NSAIDS different?
Definition
Non-selective induce: gastric ulceration, inhibit platelets, inhibit induction of labor, alter renal function, hypersensitivity.
Selective: Inhibit labor, alter renal function
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