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Abbas El Subai

Medical University of Lodz

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A variably unpleasant sensation associatedwith actual or potential tissue damage and

mediated by specific nerve fibers to the brainwhere its conscious appreciation may bemodified by various factors

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Short term effects :

Emotional and physical suffering

Sleep disturbance Cardiovascular effects Impaired bowel movement Effects on respiratory function Delayed mobilization, promotes thrombosis.

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Long term effects :

Acute pain can lead to chronic pain

Behavioral changes in children for a prolongedperiod after surgical pain.

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Improve quality of life for the patient

Reduce morbidity

Facilitate rapid recovery and return to full

function

Allow early discharge from hospital.

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Postoperative pain can be divided into acutepain and chronic pain:

Acute pain is experienced immediately after

surgery (up to 1 month) Chronic (more than 1 month)

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Somatic (from skin, muscle, bone) Visceral (from organs within the chest and

abdomen)

Neuropathic (caused by damage or dysfunction inthe nervous system).

Patients can experience more than one type of pain.

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Transduction Transmission Modulation

Perception

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Assess pain both at rest and on movement. Evaluate before treatment, than reevaluate after. If pain is intense, evaluate, treat, and re-evaluate

frequently. On the ward, evaluate, treat, and re-evaluate

regularly. Document pain and response to treatment, including

adverse effects.

Particular attention to patients who have difficultycommunicating pain. Evaluate unexpected intense pain, particularly if

associated with hypotension, tachycardia or fever.

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Facial expressions

Verbal rating scale (VRS)

Numerical rating scale (NRS)

Visual analogue scale (VAS)

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Proactiveness

Multimodal approach

Escalating approach

Patient control

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Evaluate, treat, and re-evaluate regularly.

Define the intervention threshold.

Give immediate pain relief without asking for apain score to patients in obvious pain.

Have predefined pain treatment plan ready and

authorized.

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Pain is complex and multifactorial, thus

appropriate management requires a balanced

therapeutic approach.

Benefits of multimodal approach:

higher effectiveness due to synergism

lower side effects due to lower doses used flexibility

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PCA stands for Patient Controlled Analgesia -the intermittent administration of analgesic drug

under direct patient control (e.g: IVadministration of Morphine).

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Non-opioid analgesics: Paracetamol (Acamol), Dipyrone (Optalgin) NSAIDs (including COX-2 inhibitors)Weak opioids: Codeine TramadolStrong opioids: Morphine Pethidine Oxycodone

Adjuvant: Ketamine Gabapentine (Neurontin), Pregabalin (Lyrica) Clonidine, Dexmedetomidine (Precedex)

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Euphoria/dysphoria Constipation respiratory depression

nausea/vomiting urinary retention. Tolarace Addiction

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Local anesthetics in epidural space produce three types of blocks: sympathetic; sensory; motor.

The resulted block is concentration depended, the sympathetic block is beenappearing first.

Postdural puncture headache (PDPH). Results from the tension force applied to meningeal and vascular

structures. May herald incipient cerebrovascular accident. Treatment:

simple analgesics; bed rest; fluid hydration; an epidural blood patch after 24 hours.

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PNB is induced by injecting LA near the course of nerves or plexuses. Cervical plexus Brachial plexus Lumbar plexus Sacral plexus

Cervical plexus The cervical plexus is formed from the first four cervical nerves (C1-C4). The most common clinical use for this block is for carotid endarterectomy. Phrenic Nerve from C3 & C4 & C5Brachial Plexus Interscalene

Supraclavicular Infraclavicular Axillary

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