Podcast
Questions and Answers
What is the principle of titrating the dose of analgesia in pain management?
What is the principle of titrating the dose of analgesia in pain management?
To level of sedation and not respiratory rate
What is the purpose of paracetamol in combination therapy for severe pain?
What is the purpose of paracetamol in combination therapy for severe pain?
Reduces need for opioids in stronger pain situations
What are some potential health risks associated with NSAIDs?
What are some potential health risks associated with NSAIDs?
Kidney, asthma, stomach, and bleeding risk.
How does ketamine work to reduce pain and improve opioid effectiveness?
How does ketamine work to reduce pain and improve opioid effectiveness?
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What are some potential side effects of ketamine at higher doses?
What are some potential side effects of ketamine at higher doses?
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What is a safer option compared to tramadol when used with MAOIs, SSRIs, and SNRIs?
What is a safer option compared to tramadol when used with MAOIs, SSRIs, and SNRIs?
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What is a better clinical indicator of respiratory depression in Opioid-Induced Ventilatory Impairment (OIVI)?
What is a better clinical indicator of respiratory depression in Opioid-Induced Ventilatory Impairment (OIVI)?
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What is the mechanism of action of local anesthetics?
What is the mechanism of action of local anesthetics?
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What is the maximum volume of ropivacaine 0.2% that can be infused epidurally per hour?
What is the maximum volume of ropivacaine 0.2% that can be infused epidurally per hour?
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What is the initial management of local anesthetic systemic toxicity (LAST)?
What is the initial management of local anesthetic systemic toxicity (LAST)?
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What is the name of the condition that occurs when opioids are used and can lead to respiratory depression?
What is the name of the condition that occurs when opioids are used and can lead to respiratory depression?
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What is the primary characteristic of chronic pain?
What is the primary characteristic of chronic pain?
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What type of pain is characterized by burning, electric shocks, tingling, and pins and needles sensations?
What type of pain is characterized by burning, electric shocks, tingling, and pins and needles sensations?
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What type of pain is often not responsive to opioids?
What type of pain is often not responsive to opioids?
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What are TCAs used for, and what are their potential side effects?
What are TCAs used for, and what are their potential side effects?
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What are the adverse effects of Opioids, and what precautions should be taken?
What are the adverse effects of Opioids, and what precautions should be taken?
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What makes Fentanyl a safer option for patients with renal impairment?
What makes Fentanyl a safer option for patients with renal impairment?
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What are the advantages of Oxycodone in patients with renal impairment?
What are the advantages of Oxycodone in patients with renal impairment?
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Study Notes
Opioids
- Tramadol inhibits noradrenaline reuptake, with minimal serotonin effect and active metabolites, which require caution in renal impairment.
- Tapentadol has minimal serotonin effect, no active metabolites, and is safer with MAOIs, SSRIs, SNRIs, and high-dose TCAs, with a lower risk of seizures.
Opioid-Induced Ventilatory Impairment (OIVI)
- Increasing sedation is a better clinical indicator of respiratory depression than oxygen saturation.
- The risk of OIVI increases with concurrent administration of sedating medications.
Regional Analgesia for Chest Wall Trauma
- Erector Spinae Plane Block (ESPB) is a regional anesthesia technique where a local anesthetic is injected between two layers of fascia.
- Serratus Anterior Plane (SAP) Block and Sub-Pectoral Plane Block are other regional anesthesia techniques.
Local Anesthetic Systemic Toxicity (LAST)
- Administering oxygen, stopping bolus, initiating medical emergency response, seizure management, and using ACLS protocols, and 20% lipid emulsion are used to manage LAST.
Epidural Infusions
- Ropivacaine 0.2% can be used for epidural infusions up to 14 ml/hr.
- Peripheral nerve block (continuous or intermittent) can be used up to 10 ml/hr.
Types of Pain
- Acute pain is recent onset, limited duration, and has an identifiable cause, with a predictable course.
- Chronic pain is persistent for more than 3 months, with a cause that is sometimes obscure or non-specific, and has an unpredictable course.
- Nociceptive pain arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors.
- Neuropathic pain is caused by a lesion or disease of the somatosensory nervous system.
- Nociplastic pain arises from altered nociception despite no clear evidence of actual or threatened tissue damage.
Pain Management
- The Bio-Psycho Social Model of Pain considers the physical, psychological, and social aspects of pain.
- Prolonged injury response and sympathetic response can lead to various complications, including hyperglycemia, increased risk of infection, and prolonged hospital admission.
Measuring Pain
- Verbal Numerical Rating Scale, Verbal Descriptor Scale, and FACES pain scale are used to measure pain.
- Functional Activity Score (FAS) is used to assess the level of function and pain scores.
Non-Pharmacological Management
- Physical methods include rest, positioning, compression, and elevation.
- Psychological methods include explanation, reassurance, distraction, and managing expectation.
Analgesic Management
- Paracetamol reduces the need for opioids in stronger pain situations and is processed by the liver and removed by the kidneys.
- Non-selective NSAIDs (e.g., Ibuprofen) affect both COX-1 and COX-2, while selective NSAIDs (e.g., Celecoxib) mainly affect COX-2.
- Ketamine is effective in controlling severe and persistent pain by blocking NMDA receptors.
- Adjuvants, such as TCAs (e.g., Amitriptyline), Anticonvulsants (e.g., Pregabalin), and Alpha-2 Agonists (e.g., Clonidine), can be used to manage pain.
Opioids
- Morphine has active metabolites M3G and M6G, which are renally excreted, and caution is required in elderly and renal impairment patients.
- Fentanyl has no active metabolites, making it safer in renal impairment patients.
- Oxycodone is a semi-synthetic opioid derivative of thebaine, with no harmful metabolites, making it safer in renal impairment patients with dose adjustment.
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