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Assessing and managing pain
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Lindsey Pollard, Harriet Barker
Patient-controlled analgesia is an approach to pain management in which the individual controls the dose and frequency of analgesics up to a predetermined limit. When practitioners refer to PCA, they generally mean the intravenous system that delivers opioids, such as morphine, oxycodone or fentanyl when a demand button is pressed. These systems are most commonly used in surgical settings and their management is covered by local protocols that include the administration of oxygen to minimise respiratory depression.
Patient-Controlled Analgesia
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
In the broadest sense, the phrase “patient-controlled analgesia” refers to a general process that allows patients to determine when and how much analgesic medication they receive, regardless of the drug used or route of administration. However, it more commonly refers to a method of pain relief which uses electronic or disposable infusion devices and allows patients to self-administer an opioid as required.
Peri-operative care
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Weak opioids (e.g. codeine phosphate, dihydrocodeine, tramadol) Strong opioids (e.g. morphine, pethidine, fentanyl)Can be administered via a number of routes: subcutaneous, intramuscular, transdermal, intravenous and via a PCA (patient controlled analgesia). PCA analgesia has the advantage of improving patient autonomy, reducing nursing workload, and reducing fluctuations in plasma concentrations of drugSide effects include sedation, nausea and vomiting, constipation, urinary retention, pruritis, respiratory depression
The intersection of harm reduction and postoperative care for an illicit fentanyl consumer after major surgery: A case report
Published in Canadian Journal of Pain, 2021
Salima S. J. Ladak, Gonzalo Sapisochin, P. Maxwell Slepian, Hance Clarke
Postoperative analgesic options were also discussed during this anesthesia assessment. Collectively, the anesthesia and surgical teams agreed to avoid neuraxial analgesia because the expected remnant liver would be less than 85% and this could result in complex coagulopathy. Based on the size and location of the tumor, a “Mercedes-Benz” incision was expected. Clear land markings for abdominal wall catheter placement for local anesthetic infusion remained unclear. Intravenous ketamine was offered and declined by DC due to previous hallucinations. Intravenous lidocaine was also considered at this point, and the dose for the same was lowered to account for a lower liver volume and its ability to metabolize lidocaine. Additional limitations included the reduced reliance on other conventional evidence-based analgesics including nonsteroidal anti-inflammatory medications and acetaminophen from both anticoagulation and liver function considerations in the context of the liver resection. Given these restrictions, the patient was going to be reliant on intravenous (IV) opioid patient-controlled analgesia postoperatively.
Periumbilical infiltration of lidocaine with epinephrine for postoperative pain reduction in single-port laparoscopic adnexal surgery
Published in Journal of Obstetrics and Gynaecology, 2018
Kyung Jin Eoh, Jung-Yun Lee, Eun Ji Nam, Sunghoon Kim, Young Tae Kim, Sang Wun Kim
This study was approved by the institutional review board of our university health system. A total of 160 patients who underwent a transumbilical SPL adnexal surgery from 2008 to 2011 were retrospectively recruited. The study group (80 patients) had a periumbilical infiltration of 30 mg lidocaine with epinephrine, subcutaneously (Figure 1(D)), whereas the control group (80 patients) received no analgesic during the repair of the umbilical incision after their SPL adnexal surgery (Figure 1(C)). The two groups were matched for their age, body mass index, frequency of their previous abdominal surgery and type of surgery. The inclusion criteria were as follows: (i) having undergone an elective adnexal surgery for benign lesions; (ii) adequate medical condition (American Society of Anesthesiologists Physical Status Classification System 1–2) of the patient, (iii) no evidence of gynaecologic malignancy on the imaging studies and (iv) CA-125 ≤ 150 IU/mL. For the exclusion criteria, we selected the following to focus primarily on evaluating the postoperative pain along with the surgical outcomes: (i) the presence of additional procedures, such as endometrial curettage, hysteroscopy, or myomectomy, at the time of the adnexal surgery; (ii) a conversion of SPL cases to conventional laparoscopy; and (iii) the administration of postoperative intravenous patient-controlled analgesia during the hospital stay.
The effect of preoperative nefopam treatment on postoperative catheter-related bladder discomfort in patients undergoing transurethral bladder tumor resection: a randomized double-blind study
Published in Scandinavian Journal of Urology, 2018
MiHye Park, Chan Hee Jee, Kyung-Hwa Kwak, Jun-Mo Park, Ji Hyo Kim
Postoperative pain was assessed by the patient according to the numeric pain rating scale (N.R.S., 0 = no pain; 10 = worst possible pain) at 1, 2, 6 and 24 h after arrival of the patients in the ward. Postoperative pain was controlled by rescue analgesics administered by hospital personnel without patient-controlled analgesia. Patients with spontaneous complaints of C.R.B.D. without question or N.R.S. ≥ 4 were treated with 50 mg tramadol intravenously. If, after tramadol was injected twice, the patient complained of C.R.B.D. or N.R.S. ≥4, the corresponding author assessed the patients for appropriate treatment. The time of first request for postoperative analgesia and the number of injections were recorded. The presence of any of the following possible complications during the postoperative 24 h was recorded by the attending anesthesiologist in the operating room and the nurses in the relevant hospital ward: tachycardia, drowsiness (no eye opening in response to a verbal command), dizziness, dry mouth, and postoperative nausea/vomiting (P.O.N.V.).