Postoperative Pain Management Lecture 1 PDF

Introduction to Postoperative Pain management Lecture 1 Virginia Plummer Slides adapted from, Chapter 6  Nurses' role in pain management What we Cultural considerations covered last Definition of pain Semester Acute vs chronic pain...

Introduction to Postoperative Pain management Lecture 1 Virginia Plummer Slides adapted from, Chapter 6  Nurses' role in pain management What we Cultural considerations covered last Definition of pain Semester Acute vs chronic pain Nociceptive vs neuropathic Do you Pain pathway need to Pain assessment tools revise? Effects of unrelieved pain WHO analgesic ladder Pain mechanisms https://youtu.be/CM_aM-0uVOM Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia 2020 Pain treatment principles 01 02 03 04 05 Follow the Use a holistic Use both Use multimodal Address pain using principles of pain approach. medication and (two or more an interprofessional assessment. non- classes of approach. pharmacological analgaesic) therapies. approach to analgaesic therapy. Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia 2020 Medication therapy— The WHO analgesic ladder Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia 2020 OPIOID Pharmacology Opioids are used for moderate to severe pain commonly the first line analgesia postoperatively Action Route & frequency Side effects > ANTAGONIST Action of opioids (see video in PREPARE section) How do opioids produce their analgesic effect? Why do we see side efffcts such as sedation, respiratory depression, euphoria and constipation? Complete self-directed activity "template in PREAPRE section" Patient Controlled Analgesia (PCA)  Assessment Assessment Assessment ▪ RR, SaO2, BP, HR, Verbal numerical pain score ▪ Functional activity score (FAS) ▪ Sedation score ▪ Assess SE’s such as nausea ▪ 1/24 documentation of demands, deliveries, cumulative total ▪ IV line & orders ▪ Frequency? Assessment of pain Verbal Numerical Rating Score (VNRS). Ask the patient to rate their pain while resting and moving Functional Activity Score (FAS) Observe your patient during the chosen activity and score A, B or C. A –No limitation meaning the patient’s activity is unrestricted by pain B –Mild limitation means the patient’s activity is mild to moderately restricted by pain C -Severe limitation means the patient ability to perform the activity is severely limited by pain Assessment of sedation level Sedation Score, rate the level of alertness from zero to 3 0 = alert 1 = awake but drowsy (1s = asleep) 2 = drowsy but rousable to voice, touch 3= unarousable barely rousable  Potential complications ▪RECOGNISE CLINICAL DETERIORATION Think about the AE’s of Opioids ▪Reduced level of consciousness ▪Respiratory depression ▪Urinary retention ▪Nauseas and vomiting ▪Pruritis Medication errors Pump failure When do you call a MET EPIDURAL ANALGESIA  EPIDURAL ANALGESIA Epidural space Small catheter inserted into space between DM and spinal bones The epidural space contains blood vessels, lymphatic vessels and spinal nerves. Spinal ; intrathecal delivery Catheter inserted into subarachnoid space Bolus or continuous infusion Bromage score (Mann, E. (2016). Managing pain. Potter and Perry's Fundamentals of Nursing (5th ed.). Sydney: Elsevier. p. 1356.) Epidural Complications Opioid related Reduced level of consciousness Respiratory depression Urinary retention Nauseas and vomiting Pruritis Epidural complications Local Anesthetic related Sensory and motor deficits Toxicity Hypotension & bradycardia Site infection Epidural abscess or Epidural hematoma Postdural headache Hemorrhagic complications  THE END