Professional Documents
Culture Documents
R. Angulo
Acting Nurse Clinician
MBOT /PACU
National University Hospital Singapore
OBJECTIVES
OBJECTIVES
.
Identify common side effects of opiods
Identify non pharmacologic
interventions useful in pain
management
Familiarize with the different types of
pain management
Gain a supplementary knowledge in
evidence based supporting
management of acute pain
GI
GU
Urinary retention
Metabolic
MSK
Psychological
Long term
Chronic pain
4 Stages of
Pathophysiology of
Acute Pain :
TransductionTransduction a
stimulus is
converted into a
nerve signal at the
nociceptors
Transmission-pain
information is
transferred from
the peripheral to
the CNS
Pain Modulation-pain
information is
interpreted by many
neurochemical
mediators; can
exagerrate or reduce
reaction to pain;
psychologic factors
affect response to pain
PerceptionPerception awareness
of pain; associated
with specific area of
the body; influenced
by social and
environmental factors
Primary lesion or
dysfunction of the
nervous system
ACUTE PAIN
C
O
L
D
S
P
- character
- onset
- location
- duration
- severity
- pattern
A alleviating/aggravating
factors
Non-stero
idal
antiinflamma
tory
drugs
(NSAIDS)
Acetamin
oph
en
Relaxation
Techniques
Psychotherapy
Narcotics
Localized
anesthetics
Biofeedback
Nerve blocks
Acupunc
t
ure
Physica
l
Therapy
Surgery
Behavior Modification
Electrical stimulatio
of pain
- 0 indicates the absence of pain, while 10 represents the most
-intense
rate pain
aspossible
mild, moderate
or severe, which can indicate a
pain
.
potential disability
level
FLACC Scale
1
1
1
2
1
1
1
6
behavioral tool to measure pain in young children
designed for children between the ages of 2 months and 7 yrs
unable to communicate their pain
Face muscles
relaxed
Facial muscle
tension, frown,
grimace
Frequent to
constant frown,
clenched jaw
Face score:
Quiet, relaxed
appearance,
normal
movement
Occasional
restless
movement,
shifting position
Frequent
restless
movement may
include
extremities or
head
Restlessness
score:
Muscle
toneMuscle
tone *
Normal muscle
tone
Increased tone,
flexion of
fingers and
toes
Rigid tone
Muscle tone
score:
Vocalisation **
No abnormal
sounds
Occasional
moans, cries,
whimpers and
grunts
Frequent or
continuous
moans, cries,
whimpers or
grunts
Vocalisation
score:
Consolability
Content,
relaxed
Reassured by
touch,
distractible
Difficult to
comfort by
touch or talk
Consolability
score:
Face
Restlessness
Total
** cannot be measure
in patients with artifi
airways.
PATIENT CONTROLLED
ANALGESIA
CADD LEGACY
PCA
handset
ot re
n
s he
i
A .t r
C
If P ible othees
ss an tiv
o
p are rna
e
alt
Epidural
catheter with
the skin site marking
ADVANTAGES OF ECA
provide complete dynamic analgesia with a
combination of local anaesthetic and opiods
obtunds the stress response to major surgery
reduce the incidence of postoperative
pulmonary, thromboembolic and cardiac
complications
enhance the quality of patient recovery from
major surgery and shorten hospital stay
risk of serious complications from epidural
analgesia should be far outweighed
DISADVANTAGES OF ECA
causes respiratory depression
Axillary Block
Brachial Plexus
Block
mhon_nhette14@yahoo.com
monserrat_espinoza@nuhs.edu.sg