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post operative pain and regional anaesthesia

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post operative pain and regional anaesthesia

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    1. Post operative Pain and Regional Anaesthesia Dr Maya Nagaratnam FFPMRCA FRCA

    3. Why is it important to control pain? Divinum sedare dolorem Reduce Sympathetic activity ( ACS) Reduce respiratory complications Reduced chronic pain syndromes Improved mobilisation Improved patient satisfaction

    4. Divinum sedare dolorem

    5. Reduce respiratory complications

    6. Reduce Sympathetic activity ( ACS)

    7. Improved mobilisation

    8. Reduce Chronic Pain Syndromes

    9. Improved patient satisfaction

    10. Case 1 It is your first on call as a Gas person. Bleeped about Mrs X DSU laproscopic cholesystectomy; admitted overnight for uncontrolled pain. PONV

    11. Put the following in the right order A. d/w Spr B. management plan C. history and pain assessment D. check notes, anaesthetic and drug charts

    12. D, C, B ,A D. check notes, anaesthetic and drug charts C. history and pain assessment B. management plan A. d/w Spr

    13. Pain Assessment

    14. Management Options A. regular oral analgesia eg paracetamol, diclofenac, prn Im morphine B. regular IV paracetamol, prn IM morph, IVF, antiemetic C. morphine PCA D.Immediate IV morphine 0.5-1mg/kg titrate in 2mg aliquots E. C +D+ IVF+ antiemetic.

    15. WHO analgesic ladder....1, 2, 3

    16. Analgesia Simple(mild) Paracetamol NSAIDs Moderate Codeine Tramadol

    17. General points Ladder -Breakthrough pain - strong analgesics as per WHO pain ladder Oral -Regular oral analgesia ASAP Others -Treat co existing symptoms; fluids, antiemetic, laxatives , oxygen

    18. CASE 2 57 y old 3d post laporotomy, thoracic epidural, can take free fluids Excruciating pain last 2 h A. Morphine PCA B. Notes, drug chart C. D/W SpR D. Hx, examination ( epidural site) E. Regular oral analgesia, breakthrough morphine F.Bolus/ top up

    19. B, D, F, E, A, C B. Notes, drug chart D. Hx, examination ( epidural site) F. Bolus/ top up E. Regular oral analgesia, breakthrough morphine A. Morphine PCA C. D/W SpR

    20. Regional analgesia Peripheral nerve block Mainly extremeties, particularly ortho Epidural Used as both analgesia and anaesthetic, usually catheter in situ can top up Spinal Similar to epidural , but lower concentrations required, rarely catheter in situ, continuous prolonged analgesia not appropriate

    21. Peripheral Nerve Block

    22. Spinal (A) v Epidural (B)

    23. Summary – control of POP

    24. General concepts pain treatment L O O

    25. General concepts pain treatment L (ladder) – WHO pain ladder ; stepwise increment of strength of analgesia; start at appropriate level O (oral) establish oral analgesics ASAP O (other assoc. symptoms ) Treat N, V, dehydration, constipation, anxiety.

    27. Learning Objectives List 6 important reasons for post operative pain control Choose appropriate analgesic regimes Know when to call for senior advice

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