Fichas
Analgesia
Fichas del conjunto (39)
- 1OpioidsControlled under Misuse of Drugs Act
Similar modes of action, activity varies between receptors - mu, kappa, sigma, delta
Full-mu agonists (morphine) most reliable pain relief - 2Types of pain Referred pain:Experienced from site distant from injury
- 3Types of pain Phantom pain:Sensation or burning or tingling experienced in absent limb
- 4Types of pain Neuropathic pain:Abnormal processing of nervous activity resulting from injury to higher centres of brain
- 5Controlling painEndorphins
Local anaesthetic agents
Opioids
Non-steroidal anti-inflammatory drugs (NSAIDs)
NMDA receptor agonists - 6EndorphinsEndogenous opiate-like peptides produced naturally in CNS
Inhibit production of neurotransmitter substance & conduction of pain impulses
Raise pain threshold & produce sedation & euphoria
Production stimulated by TENS/acupn - 7Local anaestheticBlock all sensory input from affected area
Site of injury will determine usefulness
Bupivicaine or ropivacaine drugs of choice due to duration or action (not licensed) - 8Topical - EMLA cream applied prior to catheter placement Local block - multiple injs in LA around area of interest with fine bore needle Local 'splash' block - Irrigating wound with LA prior to closureRegional block - LA admin around nerve, desensitising whole area it supplies
Epidural - LA inj into epidural space between dura mater & periosteum providing desensitisation of all nerves leaving spine from there - 9OpioidsPartial mu agonists - eg Buprenorphine
Less reliable against wide pain type
Poor dose/response relationship
If ineffective increasing dose often does not increase analgesic effect
Difficult to change to alternative - 10Effects of opioid analgesiaAnalgesia, sedation, euphoria (cats), resp depression, cough suppression, nausea, V+, constipation, mydriasis (pupillary dilation)
- 11Types of pain Visceral pain:Smooth muscle walls (abdomen, cranium, thorax)
Difficult to localise
Cramping/burning - 12Examples of opioidsMorphine, Pethidine, Papaveretum, Methadone, Fentanyl, Etorphine, Buprenorphine, butorphanol
- 13Admin of opioidsiv - not pethidine, i/m - pethidine stings
s/c - variable uptake
Oral - metabolism affects efficacy
Sublingual - technically difficult
Rectal - Suppositories
Epidural - GA, sterilty, skill needed
Transdermal - Fentanyl patches - 14NSAIDsInhibit synthesis or prostaglandins, production of COX
Block peripheral sensitisation
Long duration of effect
Antipyretic
No sedation - 15NSAIDsGreater effect if given pre-emptively
Carprofen, Meloxicam, Tepoxalin
Compromise renal blood flow
GI ulceration in long term use - 16NMDA receptor agonistsN-methyl-D-aspartate agonist
Ketamine, tiletamine - excellent for somatic/neurological pain, poor for visceral
Shot duration of action - 17NMDA receptor agonistsIncreased doses produced increased analgesia but also dissociativeness
Excellent analgesic as slow infusion either alone or in combo with morphine/lidocaine (IVFT)
Observe for toxicity if lidoc used
Synergy with opioids - 18Objective assessment of painSimple scoring system useful for standardising pain assessment
Assessment of patient behaviour, general demeanour, appetite, pain response
Freq of assessment depends on presenting problem - 2h - 19Objective assessment of painMany pain scales produced with no single accepted method. Tailoring to individual practice needs is important
Patients with chronic pain should be assessed every 3m or when meds ineffective - 20Scoring System0 = no pain, signs of discomfort, resentment to firm pressure
1 = some pain, no discomfort, resentment to firm pressure
2 = mod pain, some discomfort, made worse by firm pressure
3 = severe pain, overt signs of persistent discomfort, made worse by firm pressure - 21PostureAbnormal posture, guarding/protecting painful area of straining
Unresponsive sternal or sitting position with hunched back & head low (Cats)
Attempting to rest in abnormal position - 22Pain is individual and depends on ...Age - young have lower tolerance, elderly may not express pain as plainly
Health status
Species variation (prey animals)
Breed differences - 23Advantages of painLimits extent of injury
Encourages rest and healing
Individual leanrs to avoid noxious stimuli in future - 24Disadvantages of painDistressing, may increase recovery time
Enhances stress response, increasing catabolism and delaying wound healing
Anorexia
Impairs respiration resulting in reluctance to cough and mucous retention - pneumonia - 25Disadvantages of pain 2Self mutilation
Sensitisation of CNS - 26Recognising painWhat is normal for patient?
Changes in personality or attitude
Quiet docile becomes aggressive
Aggressive animal becomes quiet
Vocalisation, behaviour, movements
Posture, physiological parameters - 27VocalisationExcessive in dogs
Spontaneous in cats thuogh less vocal
Growling and hissing on manipulation of painful area - 28BehaviouralHyperventilation, Agitation, Reduced grooming
Decreased or no appetite
Dsiturbance to normal sleep pattern
Inappropriate U+/F+
Changes in bowel movements (D+) - 29Behavioural 2Aggression/resentment of handling
Seek solitude or human reassurance
Intereference of woundsite
Attempts for escape with aggression
Horses - excessive sweating/salivation
Rabbits - grinding teeth
Changes in facial expression - 30MovementRestlessness/reluctance to move
Stiffness of limbs, gait change, inability to rise
Reluctance to lie down
Reduced activity
Trembling, shaking, thrashing - 31DefinitionPain is the conscious perception of noxious stimuli
- 32Physiological ParametersIncreased heart & resp rate
Raised body temp
Mydriasis (dilated pupils)
Blood biochem elevations - eg glucose, corticosteroid, catecholamine conc - 33Analgesia is underusedVets get away with it
Pian difficult to assess
Ignorance
Misconceptions regarding use of analgesic drugs - 34Analgesia is underused 2Misuse of drugs act
Limited no. of licensed analgesic products
Inertia/complacency
Reservations about side effects
Different attitudes-generation gap - 35Why treat pain?Correlation from humans
Ethicla reasons, O' expectation
Common anaesthetic agents have little or no analgesic effect
Optimise recovery/healing times
Minimise pain = minimise self-trauma - 36Types of PainAcute pain
Chronic pain - 37Acute painSudden onset, immediately after injury
Disappears when injury healed
Intensity greatest in 24-72 hours
Mild-severe, short duration, quickly resolves with tx - 38Chronic painProlonged pain - 6 months
Sudden or gradual with periods of remission or exacerbation
May not be associated with injury
Difficult to treat - 39Types of pain Somatic pain:Ligaments, tendons, bones
Easily localised throbbing/stabbing pain
Información
- Descripción
- Advanced Veterinary Nursing Fichas sobre Analgesia, creado por serenacutbill el 21/05/2013.
- Creado por
- serenacutbill
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