Pain Management Post Op

Question 1

Adjuvants?

Answer 1

Drugs used in conjunction with opioids and non opioids

• remove side effects of analgesics
• properties assist and relieve pain

Sometimes referred to as coanalgesic

Adjuvants are used at every step in the WHO ladder

Question 2

Breakthrough pain?

Answer 2

Pain that occurs despite treatment

Question 3

PCA?

Answer 3

Patient controlled analgesia

Method of pain control designed to allow the patient to administer pre set dosages of an analgesic I

Question 4

Nociceptive pain?

Answer 4

Pain caused by damage to somatic or visceral tissue

Question 5

Neuropathic pain?

Answer 5

Pain caused by damage to nerve cells of changes in spinal cord processing

Question 6

Pain threshold vs tolerance?

Answer 6

Threshold: the point beyond which a stimulus causes pain

Tolerance: max level of pain a person is able to tolerate

Question 7

What’s is a sedation scale?

Answer 7

A number to assess level of sedation of a patient
The higher the number the more sedated they are
0-4

-RASS
(Richmond agitation sedation scale)

Question 8

True of false

Nociceptive pain occurs when there is damage to somatic and/or visceral tissue?

Answer 8

True

Question 9

Neuropathic pain vs Nociceptive pain?

Answer 9

Neuropathic:

• burning, shooting, electric pain
• difficult to treat
• involves nerves

Nociceptive:

• aching/throbbing pain
• responsive to opioids and non opioids
• involves tissue

Question 10

Why is the WHO ladder a little different for surgical patients?

Answer 10

You start high and titrate down

(3) strong opioid
(2) weak opioid
(1) non opioid

Question 11

Examples of adjuvants?

Answer 11

Corticosteroids
Antidepressants
Muscle relaxant
Anti inflammatory

Question 12

What is pain?

Answer 12

Multidimensional
Objective and subjective
Pain is what the person says it is
Complex

Question 13

Pain assessments?

Answer 13

PQRST
Faces, 0-10
Non verbal body language

Question 14

What effects a persons pain goal?

Answer 14

Individualized based on patient needs
Different pain tolerance/threshold
Gender, age
Cultural considerations

Question 15

2 types of Nociceptive pain?

Answer 15

Somatic: skin, mucosa, muscles, joints, bone
-sharp, constant, throbbing, gnawing, aching

Visceral: organ, GI tract
-dull, cramping, squeezing, deep, aching

Question 16

Multimodal pain management?

Answer 16

The use of more than than 1 form of analgesia at the same time that is satisfactory to the patient

Question 17

Can Nociceptive and neuropathic pain be chronic?

Answer 17

Both types can become chronic

Typically surgical patient pain is more acute

Question 18

Physiological effects of untreated pain?

Answer 18

Increase in vitals 
Changes in cognition
Decrease sleep or bed seeking 
Decrease appetite
Delayed healing 
Diaphoretic 
Nausea
Photosensitivity 
Increase risk of infection 
GI and GU changes

Question 19

Consequences of untreated pain?

Answer 19

Decrease patient satisfaction
Decrease compliance
Increased recovery time
Hospital readmissions
Decreased QOL

Question 20

Factor contributing to poor pain management?

Answer 20

Inadequate assessments
Failure to consider available pain therapies
Attitudes/beliefs 
Poor pt compliance
Fear of addiction
Misconceptions
Lack of education

Question 21

How is post op pain different?

Answer 21

Pain is d/t tissue and nerve endings being traumatized
Pain is normally localized to the incision because it’s the primary location of trauma
Perception of post op pain is individualized

Question 22

Post op pain assessment?

Answer 22

PQRST
Pain assessment at rest and movement
Break through pain ex. During dressing changes

Question 23

Non pharmacological pain management tools commonly used in surgical units?

Answer 23

Explanation and reassurance 
Warm blankets 
Ice
Limb elevation
Ensuring drains are not pulling

Question 24

Pharmacological postoperative pain management?

Answer 24

WHO analgesic ladder
Around the clock dosing
Mixed analgesic drugs
-holistic pain management

Question 25

Common analgesic routes?

Answer 25

Oral: peaks 30-60min
SR opioids last 8-12hrs
IR opioids lasts 3-4hrs
IM: peaks 10-30min
Subcu: peaks 10-20min
IV: rapid onset, only lasts 1-4hrs
Epidural: onset 6-30min 
Spinal 
PCA

Question 26

Examples of analgesics used on the WHO ladder?

Answer 26

Strong opioids: hydromorphone, morphine, fentanyl

Weak opioids: Tylenol 3, codeine

Non opioids: Advil, ibuprofen

Question 27

Analgesic gaps?

Answer 27

Specific time periods when the management of post op pain is often inadequate

• transfer between services/hospital location
• transition from IV/PCA/epidural to oral or alternative therapy
• periods when breakthrough pain is experienced

Question 28

Considerations of pain management for older adults: physiological changes?

Answer 28

Increase disease process
Loss of muscle and fat
Decrease in cognitive reserves
Level of independence is decreasing
Dementia?
Multi-morbidities?
May not be able to verbalized their pain

Question 29

Pharmacological considerations in the older adult?

Answer 29

Acetaminophen is very effective
NSAIDS cause morbidity and mortality
Neuropathic adjuvants are not well tolerated
Midazolam is the only benzo tolerated because the rest causes neuroexcitation

Question 30

How delirium different from dementia?

Answer 30

Sudden/acute onset
Medical emergencies
Fatal
Reversible/treatable

Question 31

Causes of delirium?

Answer 31

Levels of dementia
Reaction to anaesthetic 
Reaction to meds
Acute/untreated pain
Electrolyte imbalances
Blood/fluid loss
Potential infection
Alcohol withdrawal
Constipation

Question 32

What to do if someone is delirious?

Answer 32

Comprehensive assessment
Explore hx to determine baseline orientation
Treat for pain
Consider changing the dose of type of opioid
Reassure family and seek their help

Question 33

What are some basic principles of pain treatment?

Answer 33

Routine assessments
Untreated pain complicates recovery
Patients self report should be used whenever possible
Involve patient and family
Always accept patients pain reports and document them