acute postoperative pain 2015 part 1.pptx
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7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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TEXTBOOK (MILLER) : OTHER REFERDr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
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ROBERT H*RLE+ ,-MIE D M*R.H+CHRISTO.HER L *
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.-IN .-TH-+S -ND THENE*ROBIOLO/+ OF NOCICE.T
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S'r$er0 pr1'&e" #i""'e in2'r0 !i#h &n"e3'en# re
f hi"#a4ine an1 in5a44a#r0 4e1ia#r" "'&h a"
pep#i1e"(e$6 7ra108inin)6 lipi1" (e$6 pr"#a$lan1in")6ne'r#ran"4i##er"
(e$6 "er#nin)6 an1 ne'r#rphin" (e$6 nerve $fa&#r)
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Ne'r#rphin9
Di4eri& $r!#h fa&#r" #ha# re$'la#e 1evelp4e4ain#enan&e f &en#ral an1 peripheral nerv'" "
Me47er" f #hi" pr#ein fa4il0 in&l'1e
Nerve $r!#h fa&#r (N/F)
Ne'r#rphin; (NT;)
Brain1erive1 ne'r#rphi& fa&#r (BDNF)
Ne'r#rphin<=> (NT<=>)
Encyclopedia of Pain. G.F. Gebhart , Robert F. Schmidt . Springer; 2nd ed. 201Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
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7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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De@ni#in f &er#ain &la""e" f "#i4'li a" n?i'" &rea#in f #he #er4 n&i&ep#r (n&ire&ep#r) !e'#$r!#h" f #he 1i"p'#e in #he la#e A#h Cen#'r0#he "en"r0 na#'re f pain
Charle" Sherrin$#n (A)6 an e4inen# ph0"il$#he #i4e6 prp"e1 #ha# pain r1inaril0 re"'l#" frin2'r0
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He "'$$e"#e1 #ha# even#" pr1'&in$ 1i"r'p#in fr repre"en#in$ a ph0"i&al #hrea# # i#" in#e$ri#0 &la7ele1 n?i'" re$ar1le"" f #heir na#'re6 #here7prvi1in$ an en&4pa""in$ 1e@ni#in fr #he "#i4ev8in$ pain
In #hi" &n&ep#6 "en"e r$an" "i$nalin$ #he pre"enn?i'" even#" !ere la7ele1 n&ire&ep#r" (n!"hr#ene1 # n&i&ep#r")
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N?i'" "#i4'l'" :I" ne #ha# i" painf'l an1 p#en#iall01a4a$in$ # nr4al #i""'e" S#i4'li #hpainf'l &an 7e #her4al6 4e&hani&al r
&he4i&al
Encyclopedia of Pain. G.F. Gebhart , Robert F. Schmidt . Springer; 2nd ed. 201Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
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N&i&ep#r
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Har4f'l "#i4'li a&#iva#e #he peripheral en1in$" fpri4ar0
aeren# ne'rn"6 al" &alle1 n&i&ep#r"
Their &ell 71ie" lie in #he 1r"al r# $an$lia (DR#he #ri$e4inal $an$lia
Encyclopedia of Pain. G.F. Gebhart , Robert F. Schmidt . Springer; 2nd ed. 201
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Di"#in&# &la""e" f n&i&ep#r" en&1e 1i"&re#e in#an1 41ali#ie" f n?i'" "#i4'li
Re&ep#r 4le&'le" #ha# len1 #he"e "pe&i@& prpe1iver"e &la""e" f n&i&ep#r" an1 4e1ia#e #ran"1have 7een &lne1
Encyclopedia of Pain. G.F. Gebhart , Robert F. Schmidt . Springer; 2nd ed. 201
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Sin&e #he na#'re an1 in#en"i#0 f n?i'" "#i4'li !ill var0 fr 1ie#i""'e"6 #he re"pn"ive &hara&#eri"#i&" f n&i&ep#r" !ill 1ier fr#i""'e # an#her
NOCICE.TORS CL-SSIFIC-TIONS
Encyclopedia of Pain. G.F. Gebhart , Robert F. Schmidt. Springer; 2nd ed. 2013 edition
AEe&#ive S#i4'li
Cn1'&#in Gel&i#0
;Mle&'lar Fea#'re"
< Ti""'e f Ori$in
>Cen#ral .r2e&#in
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TR.GA i" #he en1$en'" re&ep#r #ha# i" "ele&#iva&#iva#e1 70 &ap"ai&in
Ganilli1 re&ep#r !hi&h "erve" a" a #ran"1'&er fn?i'" #her4al an1 &he4i&al (e$ pr#n") "#i4&an 7e a&#iva#e1 70 &ap"ai&in6 #he a&#ive in$re1ieh# &hili pepper"
Encyclopedia of Pain. G.F. Gebhart , Robert F. Schmidt . Springer; 2nd ed. 201Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
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Relea"e f in5a44a#r0 4e1ia#r" a&#iva#e" perin&i&ep#r"6 !hi&h ini#ia#e #ran"1'&#in an1 #ran"f n&i&ep#ive infr4a#in # #he &en#ral nerv'"
(CNS) an1 #he pr&e"" f ne'r$eni&in5a44a#in6 in !hi&h relea"e f ne'r#ran"4i##e"'7"#an&e . an1 &al&i#nin $enerela#e1 pep#i1e) peripher0 in1'&e" va"1ila#a#in an1 pla"4ae?#rava"a#in
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N?i'" "#i4'li are #ran"1'&e1 70 peripheral n&ian1 #ran"4i##e1 70 -1el#a an1 C nerve @7er" frperipheral vi"&eral an1 "4a#i& "i#e" # #he 1r"a#he "pinal &r16 !here in#e$ra#in f
peripheral n&i&ep#ive an1 1e"&en1in$ 41'la#r
(ie6 "er#nin6 nrepinephrine6 a4in7'#0ri& a&en8ephalin) &&'r"
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N?i'" "#i4'li are #ran"1'&e1 70 peripheral n&ian1 #ran"4i##e1 70 -1el#a an1 C nerve @7er" frperipheral vi"&eral an1 "4a#i& "i#e" # #he 1r"a#he "pinal &r16 !here in#e$ra#in f
peripheral n&i&ep#ive an1 1e"&en1in$ 41'la#r
(ie6 "er#nin6 nrepinephrine6 a4in7'#0ri& a&en8ephalin) &&'r"
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F'r#her #ran"4i""in f n&i&ep#ive infr4a#in i"1e#er4ine1 70 &4ple? 41'la#in$ in5'en&e" in"pinal &r1
S4e i4p'l"e" pa"" # #he ven#ral an1 ven#rla#ehrn" # ini#ia#e "e$4en#al ("pinal) re5e? re"pn"!hi&h 4a0 7e a""&ia#e1 !i#h:
In&rea"e1 "8ele#al 4'"&le #neInhi7i#in f phreni& nerve f'n&#in
De&rea"e1 $a"#rin#e"#inal 4#ili#0
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O#her" are #ran"4i##e1 # hi$her &en#er" #hr'$h "pin#hala4i&
an1 "pinre#i&'lar #ra&#"6 !here #he0 in1'&e"'pra"e$4en#al
an1 &r#i&al re"pn"e" # 'l#i4a#el0 pr1'&e #he
per&ep#in f an1 ae&#ive &4pnen# f pain
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N?i'" "#i4'li % N&i&ep#in :
A Ne'r$eni& in5a44a#in (S. C/R.) De"&en1in$ 41'la#r0 inp'# (ie6"er#nin6NE.6 a4in7'#0ri& a&i16 enKeph
;I4p'l"e" pa"" # #he ven#ral an1 ven#rla
hrn" (("pinal) re5e? re"pn"e")< Spin#hala4i& an1 "pinre#i&'lar #ra&#"
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Cn#in''" relea"e f in5a44a#r0 4e1ia#r":Sen"i#iza#in f peripheral n&i&ep#r" 4a0 &&'r4ar8e1 70
De&rea"e1 #hre"hl1 fr a&#iva#in
In&rea"e1 ra#e f 1i"&har$e !i#h a&#iva#inIn&rea"e1 ra#e f 7a"al ("pn#ane'") 1i"&har$e
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Sen"i#iza#in
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.eripheral Sen"i#iza#in
In5a44a#r0 4e1ia#r" "'&h a" pr"#a$lanenhan&e #he "en"i#ivi#0 f n&i&ep#r"6 a pr1e"&ri7e1 a" peripheral "en"i#iza#in
c!te pain management , "aylor # Franci$ Gro!p. %R% pre$$ 201&
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On$in$ peripheral n&i&ep#ive "#i4'li !ill in&ree?&i#a7ili#0 f ne'rn" in #he "pinal &r16 lea1in$&en#ral "en"i#iza#in
.eripheral an1 &en#ral "en"i#iza#in re"'l# in
a4pli@&a#in f "'7"e3'en# pain "#i4'li an1 a lpain #hre"hl1
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In#en"e n?i'" inp'# fr4 #he peripher0 4a0 al"in &en#ral
"en"i#iza#in an1 h0pere?&i#a7ili#0
Cen#ral "en"i#iza#in:
.er"i"#en# p"# in2'r0 &han$e" in #he CNS #ha# re"pain h0per"en"i#ivi#0
H0pere?&i#a7ili#0:
E?a$$era#e1 an1 prln$e1 re"pn"ivene"" f nenr4al aeren# inp'# af#er #i""'e 1a4a$e
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I# "ee4" #ha# &er#ain re&ep#r" (e$6 N
4e#h0l1a"par#a#e JNMD-) 4a0 7ee"pe&iall0 i4pr#an# fr #he 1evelp4e&hrni& pain af#er an a&'#e in2'r06 al#h#her ne'r#ran"4i##er" r "e&n1
4e""en$er ee&#r" (e$6 "'7"#an&e .pr#ein 8ina"e C) 4a0 al" pla0 i4pr#rle" in "pinal &r1 "en"i#iza#in an1 &hpain
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N?i'" "#i4'li &an pr1'&e e?pre""in f n$ene" (!hi&h are #he 7a"i" fr ne'rnal"en"i#iza#in) in #he 1r"al hrn f #he "pina!i#hin A h'r6 an1 #he"e &han$e" are "'&al#er 7ehavir !i#hin #he "a4e #i4e fra4e
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The in#en"i#0 f a&'#e p"#pera#ive pain i" "i$ni@&an# pre1i&#r f &hrni& p"#pera#ive
Chrni& p"#"'r$i&al pain: C.S.
'miller(
.er"i"#en# p"#"'r$i&al pain: ...
'Some reference$(
.er"i"#en# ."# S'r$i&al .ain: ..S.
'Some reference$(
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.ain T0pe"
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.ain
c!te pain management , "aylor # Franci$ Gro!p. %R% pre$$ 201&
Nociceptive pain Somatic )i$ceral
Neuropathicpain
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Nociceptive pain
M"# &44n #0pe f pain "een in #he a&'#e &lini&al "e##in$
Somatic Sharp6 h#6 r "#in$in$ pain !'"'all0 !ell
l&alize1 # #he area f in2'
)i$ceral D'll6 &ra4pin$6 r &li&80 paini" f#en prl0
l&alize1 .ain 4a0 7e referra !i1e area
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Ne'rpa#hi& pain
H? f In2'r0 f peripheral r &en#ral nerv'" "0"
.ain &n@ne1 # #he innerva#in area &rrela#in$#hi" 1a4a$e6 7'# prl0 l&alize1
.ain i" 7'rnin$6 "h#in$6 r "#a77in$ pain
.ain 4a0 7e "pn#ane'" r par?0"4al6 !i#h n
#ri$$er".ain #ha# appear" # 7e re"pn1in$ prl0 # p
.ain #ha# appear" # re"pn1 !ell # an#ine'rpaa$en#"
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Ne'rpa#hi& pain
.han#4 phen4enn
In&rea"e1 "04pa#he#i& a&#ivi#0
-ll10nia: The "en"a#in f pain in re"pn"e # a "#i4'l'" #h
n# nr4all0 &a'"e pain (e$6 li$h# #'&h)
H0peral$e"ia: -n in&rea"e1 (ie6 e?a$$era#e1) re"pn"e #
#ha# i" nr4all0 painf'l
D0"e"#he"ia": *nplea"an# a7nr4al "en"a#in"
c!te pain management , "aylor # Franci$ Gro!p. %R% pre$$ 201&
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E?a4ple" f ne'rpa#hi& pain in #he
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E?a4ple" f ne'rpa#hi& pain in #hea&'#e "e##in$
c!te pain management , "aylor # Franci$ Gro!p.Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
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-C*TE -ND CHRONIC EFFECTS.OSTO.ER-TIGE .-IN
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*n&n#rlle1 p"#pera#ive pain 4pr1'&e a ran$e f 1e#ri4en#al a&'an1 &hrni& ee&#"
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-&'#e Ee&#"
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-# ne #i4e #he re"pn"e" # a&'#e pain 4a0 hav7ene@&ial
#elel$i&al p'rp"e h!ever6 #he "a4e re"pn"eia#r$eni& na#'re f 41ern1a0 "'r$er0 4a0 7e
*n&n#rlle1 peripera#ive pain 4a0 enhan&e "4#he"e peripera#ive pa#hph0"il$ie" an1 in&reapa#ien# 4r7i1i#0 an1 4r#ali#0
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-##en'a#in f p"#pera#ive pain6 e"pe&iall0 !i#h#0pe" f anal$e"i& re$i4en"6 4a0 1e&rea"e perip4r7i1i#0 an1 4r#ali#0
The 14inan# ne'ren1&rine re"pn"e" # pain h0p#hala4i&pi#'i#ar0a1ren&r#i&al an1"04pa#ha1renal in#era&#in"
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S'pra"e$4en#al re5e? re"pn"e" # pain re"'l# in
In&rea"e1 "04pa#he#i& #ne
In&rea"e1 &a#e&hla4ine
Ca#a7li& hr4ne "e&re#in
De&rea"e1 "e&re#in f ana7li& hr4ne"
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In&rea"e1 level" f
S1i'4 an1 !a#er re#en#in
- h0per4e#a7li&6 &a#a7li& "#a#e &&'r" a"
4e#a7li"4 an1 ?0$en &n"'4p#in
Bl1$l'&"e
Free fa##0a&i1"Ke#ne71ie"
La&#a#e
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The e?#en# f #he "#re"" re"pn"e i" in5'en&e1 70
fa&#r"6 in&l'1in$ #he #0pe f ane"#he"ia an1 in#en
#he "'r$i&al in2'r06 !i#h #he e?#en# f #he "#re"" re
7ein$ prpr#inal # #he 1e$ree f "'r$i&al #ra'4
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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The ne$a#ive ni#r$en 7alan&e an1 pr&a#a7li"4 4a0 i4pe1e &nvale"&en&eh!ever6 a##en'a#in f #he "#re"" re"pan1 p"#pera#ive pain 4a0 fa&ili#a#e a
a&&elera#e #he pa#ien#" re&ver0p"#pera#ivel0
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% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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CO-/*L-TION
Na#'ral -n#i&a$'lan#"
.r&a$'lan#"
Fi7rinl0"i"
.la#ele# rea&#ivi#0
.la"4a vi"&"i#0
Deep ven'"#hr47"i"Ga"&'lar $rafail'reM0&ar1ial i"
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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• The "#re"" re"pn"e 4a0 al" p#en#ia#e p"#pei44'n"'ppre""in (#he e?#en# f !hi&h &rrela#e" !i#h #he "e"'r$i&al in2'r0 )
• H0per$l0&e4ia fr4 #he "#re"" re"pn"e 4a0 &
# pr !'n1 healin$ an1 1epre""in f i44'nf'n&#in
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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S04pa#he#i& a&#iva#in
M0&ar1ial ?0$en &n"'4p#in
M0&ar1ial ?0$en "'ppl0
.aral0#i& ile'"
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
N&i&ep#r" a&#iva#in ini#ia#e "everal 1e#ri4en#al "pi
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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N&i&ep#r" a&#iva#in ini#ia#e "everal 1e#ri4en#al "piar&":
A ."#pera#ive re"pira#r0 f'n&#in i" 4ar8e1l0 1e&rea"e16( e"
'pper a714inal an1 #hra&i& "'r$er0)
-Spinal re5e? inhi7i#in f phreni& nerve a&#ivi#0 i" an i4pr#a&4pnen# f #hi" 1e&rea"e1 p"#pera#ive p'l4nar0 f'n&#i
B p"#pera#ive pain i" al" i4pr#an# 7e&a'"e pa#ien#" pain 4
7rea#he le"" 1eepl06 have an ina1e3'a#e &'$h6 an1 7e 4re"'"&ep#i7le # #he 1evelp4en# f p"#pera#ive p'l4nar0&4pli&a#in"
Ini#ia#e "pinal re5e? inhi7i#in f $a"#rin#e"#inal #ra&# f'n&#i1ela0 re#'rn f $a"#rin#e"#inal 4#ili#0
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
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7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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Chrni& Ee&#"
Chrni& p"#"'r$i&al pain JC.S. i" a lar$el0
'nre&$nize1 pr7le4 #ha# 4a0 &&'r in A #p"#pera#ive pa#ien#" (1epen1in$ n #he #0pe "'r$er0)
# A f #he"e pa#ien#" e?perien&in$ "eve
.rl0 &n#rlle1 a&'#e p"#pera#ive pain 4a0 i4pr#an# pre1i&#ive fa&#r
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
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7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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C.S. i" rela#ivel0 &44n af#er :
li47 a4p'#a#in (; # P;)
Thra( ( # Q)
Brea"# "'r$er0 (AA # >Q)
/all7la11er "'r$er0 ('p #>)
S#ern#40 (Q)
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% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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-l#h'$h "everi#0 f a&'#e p"#pera#ipain 4a0 7e an i4pr#an# pre1i&#r in
1evelp4en# f C.S.6 #her fa&#r" (iearea f p"#pera#ive h0peral$e"ia) 44re i4pr#an# in pre1i&#in$ #he1evelp4en# f C.S.
One "'&h fa&#r 4a0 7e #he "everi#0 pa#ien#" prepera#ive pain
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
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7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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F-CTORS fr
...
.repera#iveIn#rapera#ive."#pera#ive
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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.REO.ER-TIGE F-CTOfr ...
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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The 4ain 3'e"#in re4ain" # 7e an"!ere1 a" #
ne'rpa#hi&
v" #he in5a44a#r0 &4pnen# in per"i"#en#p"#"'r$i&al pain9
Ne'rpa#hi& &4pnen# pr7a7l0 i" 14inan#
Po$toperati*e pain + $cience and clinical practiceSmith, -ar /SP Pre$$ .201Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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Main .repera#ive fa&#r" fr ...: +'n$ a$e
.repera#ive pain
."0&h"&ial fa&#r" (an?ie#06 pain &a#a"#rphizin$6 e#
/ene#i& &hara&#eriza#in9
Po$toperati*e pain + $cience and clinical practiceSmith, -ar /SP Pre$$ .201&
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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• O#her fa&#r"
• .re#rea#4en# !i#h pii1" 9
• Fe4ale $en1er
c!te pain management , "aylor # Franci$ Gro!p. %R% pre$$ 201&
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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INTR-O.ER-TIGE F-CTO
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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Po$toperati*e pain + $cience and clinical practiceSmith, -ar /SPPre$$ .201&
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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C.S. i" rela#ivel0 &44n af#er :
li47 a4p'#a#in (; # P;)
Thra( ( # Q)
Brea"# "'r$er0 (AA # >Q)
/all7la11er "'r$er0 ('p #>)
S#ern#40 (Q)
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
Nerve in2'r0 i" #he 4"# i4pr#an# pa#h$eni& fa&#...
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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...
Hernia "'r$er0:
Ne!er "'r$i&al #e&hni3'e" # avi1 nerve in2'r0 h
7een 1evelpe1 an1 !here #he lapar"&pi& #e&hnlea1" # an al4"# > re1'&#in f nerve in2'r0 a
The &hi&e f 4e"h i" i4pr#an#6 "in&e li$h#!ei$h#4e"he" re1'&e ...
In $rin hernia "'r$er06 in#rapera#ive nerve i1en#4a0 re1'&e ...
Po$toperati*e pain + $cience and clinical practiceSmith, -ar /SP Pre$$ .201&
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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In 7rea"# &an&er "'r$er0:
The in#er&"#7ra&hial nerve i" 7vi'"l0 a# ri"8 7far #he "#'1ie" n 1ieren# "'r$i&al #e&hni3'e" fr"parin$ are in&n&l'"ive
In #hra&i& "'r$er06 #he 1evelp4en# f #he vi1ea""i"#e1 #e&hni3'e "ee4" pr4i"in$
Po$toperati*e pain + $cience and clinical practiceSmith, -ar /SP Pre$$ .201
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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The &hi&e f $eneral ane"#he"ia i" pr7a7l0 n#
i4pr#an# al#h'$h preli4inar0 1a#a "'ppr# #he7ene@&ial ee&# f a prpfl7a"e1 #e&hni3'e
Po$toperati*e pain + $cience and clinical practiceSmith, -ar /SP Pre$$ .201
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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- re&en# '#&4e anal0"i" in pa#ien#" !h re
ni#r'" ?i1e Q in ?0$en 1'rin$ #heir "'r$pr&e1're "ee4" # "h! 7#h a l!er in&i1e(Q ver"'" A< in #he air?0$en $r'p) an1re1'&e1 "everi#0 f ..S. a# ; 4n#h" af#er "'
%han ", an %, Gin ", et al. %hronic po$t$!rgical pain after nitro!$ oide ane$2011; 1&2'11(+ 2&1420.
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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.OSTO.ER-TIGE F-CTORS
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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.len#0 f "#'1ie" have "h!n an a""&ia#in 7e#!
in#en"i#0 f
a&'#e p"#pera#ive pain an1 ...
H!ever6 a &ri#i&al revie! f e?i"#in$ 1a#a 4"#l0
in&n&l'"ive re"'l#"
Po$toperati*e pain + $cience and clinical practiceSmith, -ar /SP Pre$$ .201
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
O#her fa&#r"
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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O#her fa&#r"
."0&hl$i&al:
• Depre""in• ."0&hl$i&al v'lnera7ili#0
• Ne'r#i&i"4
• -n?ie#0
Ra1i#herap0 # #he area f "'r$er0
Che4#herap0
c!te pain management , "aylor # Franci$ Gro!p. %R% pre$$ 201&
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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C-SE
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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9
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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.reven#ive -nal$e"ia
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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The l1er #er4inl$0 f pree4p#ive anal$e"ia
# an anal$e"i& in#erven#in #ha# pre&e1e1 a "'r$in2'r0 an1 !a" 4re ee&#ive in relievin$ a&'#ep"#pera#ive pain #han #he "a4e #rea#4en# fll"'r$er0
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
De@ni#in" f pree4p#ive anal$in&l'1e
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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in&l'1eha# i" a14ini"#ere1 7efre #he "'r$i&al in&i"in
ha# preven#" #he e"#a7li"h4en# f &en#ral "en"i#iza#in refr4 in&i"inal in2'r0 nl0 (ie6 in#rapera#ive peri1)
ha# preven#" &en#ral "en"i#iza#in re"'l#in$ fr4 in&i"inain5a44a#r0 in2'r0 (ie6 in#rapera#ive an1 p"#pera#ive
The en#ire peripera#ive peri1 en&4pa""in$ prepera#ivin#erven#in"6 in#rapera#ive anal$e"ia6 an1 p"#pera#ive p4ana$e4en# (ie6 preven#ive anal$e"ia)
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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.ree4p#ive anal$e"ia :
-n an#in&i&ep#ive in#erven#in #ha# "#ar#" 7efre in&i"in an1 i" 4re ee&#ive in relievin$ a&'#ep"#pera#ive pain #han #he "a4e #rea#4en# "#ar#af#er "'r$er0
Regional ne$the$ia and Pain edicine # )ol!me 35, 6!mber 1, 7an!Febr!ary 2011 P
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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.reven#ive anal$e"ia:
I" ai4e1 # 7l&8 #he 1evelp4en# f "'"#aine1 p7ra1er 1e@ni#in in&l'1e" an0 re$i4en $iven a# a#i4e 1'rin$ #he peripera#ive peri1 #ha# !ill 7e a&n#rl painin1'&e1 "en"i#iza#in
Regional ne$the$ia and Pain edicine # )ol!me 35, 6!mber 1, 7an!Febr!ary 2011 P Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#
% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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The ra#inale fr pree4p#ive anal$e"ia !a" 7a"e1
inhi7i#in f #he 1evelp4en# f &en#ral "en"i#iza#
-l#h'$h a ver0 pp'lar an1 1i"&'""e1 #her06 a anal$e"i& #rea#4en# (ei#her peripheral r ne'ra?ia
7efre #he in&i"in 1e" n# re1'&e p"#pera#ive7ehavir" 7e0n1 #he e?pe&#e1 1'ra#in f #he anee&#
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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hen #he 7l&8 f n&i&ep#ive aeren#" 1i4ini"he
"'r$i&al in2'r0 i" a7le # reini#ia#e &en#ral "en"i#iza
Fr #he"e rea"n"6 #hi" #er4inl$0 ha" 7een a7a
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
.reven#ive -nal$e"ia
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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$
Thi" 1e@ni#in 7ra1l0 in&l'1e" an0 re$
$iven a# an0 #i4e 1'rin$ #he periperaperi1 #ha# i" a7le # &n#rl painin1'"en"i#iza#in
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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S4e pa#ien#" 4a0 alrea10 have e?i"#in$ a&'#e
&hrni& pain an1 1evelpe1 &en#ral "en"i#iza#in 7#he "'r$i&al in&i"in
The"e pa#ien#" !i#h pree?i"#in$ pain 4a0 have ev4re in#en"e pain in #he p"#pera#ive peri1
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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Ti4in$ f #he in#erven#in 4a0 n# 7e a" &lini&all0
i4pr#an# a" #her a"pe&#" f preven#ive anal$e"in#en"i#0 an1 1'ra#in f #he in#erven#in)
-n in#erven#in a14ini"#ere1 7efre #he "'r$i&al i" n# preven#a#ive if i# i" in&4ple#e r in"'&ien
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
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Ma?i4al &lini&al 7ene@# i" 7"erve1 !hen &4ple
4'l#i"e$4en#al 7l&8a1e f n?i'" "#i4'li &&'re?#en"in f #hi" ee&# in# #he p"#pera#ive per
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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M*LTIMOD-L -..RO-CH T.ERIO.ER-TIGE RECOGER
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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The anal$e"i& 7ene@#" f &n#rp"#pera#ive pain are $enerall4a?i4ize1 !hen a 4'l#i41al"#ra#e$0 # fa&ili#a#e #he pa#ien#
&nvale"&en&e i" i4ple4en#e1
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
.rin&iple" f a 4'l#i41al "#ra#e$0 #hr'$h #he '"re$inal ane"#he#i& #e&hni3'e" an1 a &47ina#in
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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re$inal ane"#he#i& #e&hni3'e" an1 a &47ina#inanal$e"i& 1r'$" (ie6 4'l#i41al anal$e"ia) in&l'1&n#rl f p"#pera#ive pain # all! :
Earl0 47iliza#in
Earl0 en#eral n'#ri#in
-##en'a#in f #he peripera#ive "#re"" re"pn"e
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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The '"e f epi1'ral a14ini"#ere1 anal$e"i&
prvi1e "'perir anal$e"ia an1 ph0"il$i&7ene@#" an1 i" #herefre an in#e$ral par# f4'l#i41al appra&h
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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M'l#i41al anal$e"ia
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
7/25/2019 Acute Postoperative Pain 2015 part 1.pptx
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M'l#i41al anal$e"ia &n"i"#" f '"in$ vari'" 4
# re1'&e pain6 #h'" prvi1in$ 4re ee&#ive ana!hile re1'&in$ 1"e" an1 "i1e ee&#"
. 9habahian., R.G!pta. "he ne$the$ia G!ide. cGra:8ill Ed!cation 2013
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
*"e re$inal #e&hni3'e" !hen p""i7le
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*"e re$inal #e&hni3'e" !hen p""i7le:
Cn#in''" r "in$lein2e&#in peripheral nerve
Epi1'ral inf'"in"Nnpii1 anal$e"i&"
Opii1 anal$e"i&"
IG .C-
-12'van# 4e1i&a#in"
. 9habahian., R.G!pta. "he ne$the$ia G!ide. cGra:8ill Ed!cation 2013
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Epi1'ral anal$e"ia r even 7e##er "pinal anal$e"ia 1e&
#he area f "e&n1ar0 4e&hani&al h0peral$e"ia "'rr'n1in$ #he !e$ #he e?#en# f &en#ral "en"i#iza#in af#er pen a71"'r$er0 an1 re1'&e" #he ri"8 f 1evelpin$ ..S. (A> 4n#h" 70 &4pari"n !i#h ;Q in pa#ien#" !i#h'#ne'ra?ial 7l&8)
-a*and<homme P, =e >oc9 . "he !$e of intraoperati*e epid!ral or $pinal analge$ia po$toperati*e hyperalge$ia and red!ce$ re$id!al pain after ma?or abdominal $!rge nae$the$iol @elg 2005; &A'(+ 3A34B.
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
N?i'" inp'#" a""&ia#e1 !i#h 7#h a714inal a#hra&i& "'r$er0 are &nve0e1 70 "e$4en#al (i e
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#hra&i& "'r$er0 are &nve0e1 70 "e$4en#al (ie nerve") an1 he#er"e$4en#al (ie va$'" an1 phre
nerve") innerva#in There706 an ee&#ive 7l&8 f #he"e &4pnen#"re3'ire #he &47ina#in f 7#h anal$e"i& an1an#ih0peral$e"i& 1r'$"6 in #her !r1"6 #he '"e fpr#e&#ive anal$e"ia
-a*and<homme P, =e >oc9 . "he !$e of intraoperati*e epid!ral or $pinal anamod!late$ po$toperati*e hyperalge$ia and red!ce$ re$id!al pain after ma?or$!rgery. cta nae$the$iol @elg 2005; &A'(+ 3A34B.
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S'7ane"#he#i& 1"e" f 8e#a4ine "#rn$l0 p#en#ia#e
anal$e"ia ei#her 70 a "'pra"pinal ee&# 7l&8in$ 7ra"en"i#iza#in r 70 an an#iin5a44a#r0 ee&#
Clni1ine6 1i"pla0" an#ih0peral$e"i& prper#ie" af#er n(in#ra#he&al an1 epi1'ral) 7'# n# "0"#e4i& a14ini"#r
=e >oc9 , -a*and<homme P. aterloo$ . "he Short8-a$ting nalge$ia and -ong8"erm nECect of /ntrathecal %lonidine in Patient$ Dndergoing %olonic S!rgery. ne$th nalg 200&&A2.
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• In#raven'" li1&aine inf'"in ('p # ;
af#er #he pr&e1're) re1'&e" p"#pera#ive paini4prve" 7!el f'n&#in af#er 1i$e"#ive "'r$er0
• T1a#e6 a "in$le "#'10 ha" f'n1 a preven#ive e4n#h" af#er 7rea"# &an&er "'r$er0 in #er4" f .in&i1en&e (AAP ver"'" <Q<)
Grigora$ , -ee P, Sattar F, Shorten G. Perioperati*e intra*eno!$ lidocaine deincidence of per$i$tent pain after brea$t $!rgery. %lin 7 Pain 2013; 2'A(+ &5A
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
.a#ien#" 'n1er$in$ 4a2r a714inal r #hra&ipr&e1're" an1 !h par#i&ipa#e in a 4'l#i41al
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pr&e1're" an1 !h par#i&ipa#e in a 4'l#i41al"#ra#e$0 :
Have a re1'&#in in hr4nal an1 4e#a7li& "#r
.re"erva#in f ##al710 pr#ein
Shr#er #i4e" # #ra&heal e?#'7a#in
L!er pain "&re"Earlier re#'rn f 7!el f'n&#in
Earlier f'l@ll4en# f IC* 1i"&har$e &ri#eria
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TRE-TMENT METHODS
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Man0 p#in" are availa7le fr #he #rea#4en# f
p"#pera#ive pain:
S0"#e4i& (ie6 pii1 an1 nnpii1) anal$e"i&"
Re$inal (ie6 ne'ra?ial an1 peripheral) anal$e"i&#e&hni3'e"
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#
Mni#rin$ an1 D&'4en#a#in f ."#pera#ive
-nal$e"iaAnalgesic Medication
Medication, concentration, and dose ofd
Side %&ects
Cardiovascular: h'potensio
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drugSettings of PCA device: demand dose,lockout interval, continuous infusionAmount of drug administered(including number of unsuccessful andsuccessful doses)imits set (e!g!, "# and $#hour limits ondose administered)Supplemental or breakthroughanalgesics
brad'cardia, or tach'cardiaespirator' status: respiratlevel of sedation
Nausea and vomiting, pruritretentionNeurologic eaminationAssessment of motor block and sensor' level%vidence of epidural hemat
R'#ine Mni#rin$
Gi#al "i$n": #e4pera#'re6 hear# ra#e6 7l1pre""'re6 re"pira#r0 ra#eavera$e pain "&re.ain "&re a# re"# an1 !i#h a&#ivi#0pain relief*"e f 7rea8#hr'$h 4e1i&a#in
In"#r'&#in" .rvi1e1
Trea#4en# f "i1e ee&#"Cn&'rren# '"e f #her CNS 1e.ara4e#er" fr #ri$$erin$ n#i@&verin$ ph0"i&ian.rvi"in f &n#a&# infr4a#in1a0" per !ee8) if pr7le4" &&E4er$en&0 anal$e"i& #rea#4en
Dr Mehran Rezvani pain fell!"hip ane"#he"il$i"#% a&'p'n&#'ri"#