pacus analgesia dr. fatma aldammas. pain an unpleasant sensory and emotional experience associated...

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)


Postoperative pain differs from other types of pain


CAUSES OF VARIATION IN ANALGESIC REQUIREMENTS

• Site and type of surgery• Age, gender and body weight• Psychological factors • Pharmacokinetic variability• Pharmacodynamic variability


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.


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.


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.


Pharmacokinetic variability


• Pharmacodynamic variability


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


ALGORITHMS FOR OPIOID ADMINISTRATION


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 .


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


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


PARENTERAL ROUTES OF OPIOID ADMINISTRATION

patient-controlled analgesia (PCA)•


• 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

pacus analgesia dr. fatma aldammas. pain an unpleasant sensory and emotional experience associated...

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