Anesthesia > Pain Management > Flashcards

Pain Management Flashcards

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1
Q

Pain

A

An adverse sensory and emotional experience

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2
Q

Nociception

A

Perception of pain by the nervous system
* processed similarly in all mammals

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3
Q

4 Stages of Nociception

A
  1. Transduction
  2. Transmission
  3. Modulation
  4. Perception
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4
Q

Transduction

A

Conversion of mechanical energy into electrical energy (nerve impulses)

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5
Q

Transmission

A

Nerve impulse conducted along peripheral nerves leading to spinal cord

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6
Q

Modulation

A

Change in nerve impulse

  • impulses modified once in spinal cord
  • amplified or suppressed
  • advanced along spinal cord to brain once finished
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7
Q

Perception
What and where it occurs

A

Impulse processed and recognized as pain
*occurs in Thalamus

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8
Q

Pain & The Brain

A

Pain free region of the body
* no sensory nerves

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9
Q

Tissue Sensitivity to Pain

A

Degree of tissue sensitivity to pain is related to density of pain recepors present

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10
Q

Areas with High Density of Pain Receptors

A
  • Skin
  • Periosteum
  • Joint capsule
  • Muscle tendons
  • Arterial walls
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11
Q

Area with Low Densitity of Pain Receptors

A

Visceral and Thoracic Organs
* few sensory nerves
* visceral pain vague, hard to localize

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12
Q

Cardinal Signs of Inflammation

A
  1. Pain
  2. Heat
  3. Redness
  4. Swelling
  5. Loss of function
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13
Q

Clinical Signs of Pain

A
  • Increased HR and BP
  • Peripheral vasoconstriction
  • Pale MM
  • Rapid breathing or panting
  • Mydriasis
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14
Q

Perioperative Analgesia

A
  • Provide analgesia surrounding time of surgery
  • Multimodal Therapy & Preemptive Analgesia
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15
Q

Multimodal Therapy

A
  • Treating more than one pain receptor site at same time*
  • Prefered over using a single analgesic
  • Lower dosages used
  • Wide margin of safety

*using opioid and NSAID same time

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16
Q

“Wind up”

A
  • CNS hypersensitivity
  • Occurs with untreated, moderate-severe pain
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17
Q

“Wind up” Cause

A

Occurs when spinal cord neurons receive constant or longer term input from pain nerve fibers
* neurons become hypersensitive and hyperexcitable

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18
Q

NMDA

A
  • N-methyl-D-aspartate
  • Receptor that is activated in the spinal cord (hypersensitive)
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19
Q

Ketamine

And Wind-Up

A
  • Prevent “wind up”
  • Analgesic
  • Block NMDA receptor
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20
Q

CRI

A

Constant Rate Infusion of analgesics
* method of treating constant pain
* IV drip to administer mixture of analgesics
* Can be added to bag of IV fluids

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21
Q

CRI Medications

A
  • Morphine
  • Ketamine
  • Lidocaine
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22
Q

Opioids

A
  • Analgesic
  • Narcotics
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23
Q

Narcotics

Safety

A

Safest and most effective analgesic group available

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24
Q

Opiods

How They Work

A

Act at specific opioid receptors in CNS
* most activity in brain and spinal cord

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25
Opioid Receptors | Categories
* Mu * Kappa * Sigma * Delta * Epsilon
26
Morphine | Agonist
* Mu agonist * Produces very effective pain control
27
Buprenorphine | Agonist
* Mu agonist * Not as effective as morphine
28
Agonists
Agonists stimulate the recepors for effect
29
Antagonists
Antagonists block opioid receptors for effect * will act as a reversal agant* | EX: naloxone or nalorphine
30
Agonists and Antagonists | Mixed
Will stimulate some receptors and block other receptors * allows for analgesia while reducing addiction potential
31
Butorphanol | Mixed Agonist/Antagonist Classifications
* kappa agonist * mu antagonist
32
Butorphanol | Analgesic
* Will reverse analgesic effect of morphine * Acts as an analgesic, but not as effective as morphine
33
Narcotics | Side Effects
* Panting * Respiratory depression (in high doses) * Bradycardia * GI tract stimulation
34
Morphine
* Narcotic drug * Analgesic with some sedation * Should be given prior to painful event for greatest effect
35
Morphine | Excitement
Excitement associated with histamine release Horses * causes excitement when used without sedation Cats * causes excitement when used in high doses
36
Morphine | Side Effects
* Vomiting * Bowel evacuation * Bradycardia ## Footnote Atropine or Glycopyrollate will lessen GI side effects
37
Fentanyl
* Mu agonist * Synthetic opioid with 100x potency of morphine
38
Fentanyl | Patch
* Allows for TD administration for prolonged effect * Needs to be on for 24 hours * Provides about 72 hours of pain control * Schedule II
39
Fentanyl | Recunyra
* Transdermal solution * Applied to skin of the dorsal scapular area * Will be absorbed * One application = 4 days pain control
40
Hydromorphone
* Synthetic narcotic * 5x better analgesic than morphine * Mu agonist * Can be combines with tranquilizer (Ace)
41
Torb
* Kappa agonist * Will produce analgesia * Not as effective as morphine * Frequent redosing needed * Mild-moderate pain
42
Buprenorphine
* Partial mu agonist * Not as potent as morphine * Longer duration than torb (8 hrs) * Mild-moderate pain
43
Tramadol
* Synthetic derivative of codeine * Controlled substance * Mu agonist * Will cause sedation
44
Tramadol | Pain Control
More effective in pain control than an NSAID * may be used for longer, chronic pain (arthritis)
45
Narcotic | Reversals
* Nalorphine * Naloxone
46
Nalorphine
* Reverses effects of opioids * Very effective with morphine * Schedule III drug
47
Naloxone
* Rapidly reverses the effects of opioids * Not controlled * Effective for reversing hydromorphone
48
Selective Nerve Blocks
* Non-narcotic analgesics * Used to control pain and inflammation associated with arthritis | Ex: Carprofen (NSAID) for hip dysplasia
49
Dysplasia
Abnormal growth or development
50
Selective Nerve Blocks | Block What
Effect on peripheral tissues * blocks production of COX-1 and COX-2 * reduces production of prostaglandin
51
COX-1
Relates to the production of mucus protective layer of stomach * protects from formation of stomach ulcers Plays an important role in the renal blood supply
52
COX-2
Produces prostaglandin associated with clinical signs of inflammation
53
Prostaglandins
Produced in the process of inflammation * produce susbtances that stimulate sensory nerve cells * causes sensation of pain
54
Salicylate Analgesics
* Asprin-type products * Manage arthritis pain * May cause GI irritation* | *monitor for vomiting
55
Salicylate | For Arthritis in Cats
May be used as long as administration is controlled * not given more often than every 36-48 hours * some NSAIDS are single use only* | *not to be repeated ## Footnote Ex: Metacam
56
Carprofen
* Also called Rimadyl * Reversible inhibitor of COX-2 with some COX-1 activity
57
Carprofen | Side Effects
Most Common Include * vomiting * anorexia * lethargy
58
Onsior | Robenicoxib
* NSAID only approved for cats* * Control of postoperative pain and inflammation * Do not use with other NSAIDs or cortisones * Max use is 3 days | *need to be greater than 5.5 lbs and 6 months of age
59
Onsior | Side Effects
* Vomiting * Lethargy * Polyuria / Polydipsia ## Footnote Robenicoxib
60
Meloxicam | Metacam
Reversible inhibitor of COX-2 with some COX-1 activity
61
Meloxicam | Form and Use in cats
Injectable form approved for cats * one time only administration * other NSAID use is extra-label ## Footnote Metacam
62
NSAIDs | Patient Caution
Use with caution in patients with: * compromised renal function * cardiac disease * geriatrics
63
NSAIDs | Combinations
May be combined with opioids * for severe pain Do not combine with glucocorticoids * high potential for gastric ulcers
64
NSAIDs Use and Function
* Impare renal blood flow * Used on healthy patients undergoing moderately painful procedures or experiencing moderate pain
65
NSAIDs | General Anesthesia Length
If surgery expected to last longer than 30 minutes: * administer IV fluids * will help preserve renal blood flow
66
Sucralfate
* Treatement of gastric ulcers related to NSAIDs * Mucosal adherent that will protect ulcerated MM surface of stomach
67
Famotidine, Ranitidine, Cimetadine
* Help treat gastric ulcers related to NSAIDs * Reduce acid production in the stomach
68
Misoprostil
* Help treat gastric ulcers from NSAIDs * Promotes protective mucus layer in stomach * Prostaglandin medication * May induce labor
69
NSAIDs | with Cortisones
Should never be used together * increased chance of gastric ulcers * increases wound healing time after surgery
70
Local Anesthetics
Block selective nerves prior to or following surgery * provide good pain relief * block sodium movement across nerve cell membrane
71
Local Anesthetics | Side Effects
* Minimal
72
Local Anesthetics | Dental Procedures
Infraorbital nerve block used
73
Bupivicaine
* Local anesthetic * Infiltrate intercostal nerves after thoracic surgery * Lasts longer than lidocaine
74
Signs of Pain
* Abnormal Respiration * Increased HR * Aggression * Lack of Grooming Behavior | If signs are confusing but surgery just happened, pain likely
75
Acute Short Term | Pain Treatment
Best treated with opioid analgesics * May be combined with a tranquilizers * May also be combined with NSAIDs
76
Chronic Long Term | Pain Treatment
Best treated with NSAIDs * asprin may be used in cats* | *no more often than every 2nd day
77
Xylazine
* Alpha2 Adrenergic Agent * Causes vasoconstriction* * Good sedation and analgesic effect * Reversed with yohimbine | *increases arterial BP = lower HR and reflex vascular hypotension
78
Dexdomitor
* Alpha2 Adrenergic Stimulator * Good sedative and analgesic * May be used in CRI prep* | * for somatic and visceral pain control
79
Dex Reversal
Reversed with antipamezole
80
Gabapentin
* Analgesic and Anticonvulsant * Decreases release of excitatory neurotransmitters* | *norepinephrine
81
Gabapentin Use
* Control of chronic pain * Reduce seizures in difficult cases * Reduce anxiety
82
Gabapentin Side Effects
Seen in higher doses * Sedation * Ataxia
83
Antipyretic
Relieves fever
Anesthesia
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