1. Post operative Pain and Regional Anaesthesia
Dr Martin Rooms MB BS FRCA

2. Learning Objectives
List 6 important reasons for post operative pain control
Choose appropriate analgesic regimes
Know when to call for senior advice

3. Why is it important to control pain?
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Reduce Sympathetic activity ( ACS)
Reduce respiratory complications
Reduced chronic pain syndromes
Improved mobilisation
Improved patient satisfaction

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5. Reduce respiratory complications

6. Reduce Sympathetic activity ( ACS)

7. Improved mobilisation

8. Reduce Chronic Pain Syndromes

9. Improved patient satisfaction

10. Case 1 It is your first on call as a Gas person. Bleeped about Mrs X
DSU laproscopic cholesystectomy;
admitted overnight for uncontrolled pain.
PONV

11. Put the following in the right order
A. d/w Spr
B. management plan
C. history and pain assessment
D. check notes, anaesthetic and drug charts

12. D, C, B ,A D. check notes, anaesthetic and drug charts
C. history and pain assessment
B. management plan
A. d/w Spr

13. Pain Assessment

14. Management Options
A. regular oral analgesia eg paracetamol, diclofenac, prn Im morphine
B. regular IV paracetamol, prn IM morph, IVF, antiemetic
C. morphine PCA
D.Immediate IV morphine 0.5-1mg/kg titrate in 2mg aliquots
E. C +D+ IVF+ antiemetic.

15. WHO analgesic ladder....1, 2, 3

16. Analgesia Simple(mild) Paracetamol NSAIDs Moderate Codeine Tramadol
Strong
Fentanyl
Morphine
Adjuvants: ketamine, gabapentin

17. Ladder -Breakthrough pain - strong analgesics as per WHO pain ladder
General points
Ladder -Breakthrough pain - strong analgesics as per WHO pain ladder
Oral -Regular oral analgesia ASAP
Others -Treat co existing symptoms; fluids, antiemetic, laxatives , oxygen

18. CASE 2
57 y old 3d post laporotomy, thoracic epidural, can take free fluids
Excruciating pain last 2 h
A. Morphine PCA
B. Notes, drug chart
C. D/W SpR
D. Hx, examination ( epidural site)
E. Regular oral analgesia, breakthrough morphine
F.Bolus/ top up

19. B, D, F, E, A, C B. Notes, drug chart
D. Hx, examination ( epidural site)
F. Bolus/ top up
E. Regular oral analgesia, breakthrough morphine
A. Morphine PCA
C. D/W SpR

20. Regional analgesia Peripheral nerve block Epidural Spinal
Mainly extremities, particularly orthopaedics
Epidural
Used as both analgesia and anaesthetic, usually catheter in situ for top ups
Spinal
Similar to epidural , but lower volumes required, rarely catheter in situ, continuous prolonged analgesia not appropriate

21. Peripheral Nerve Block Consent, performance and post-block care

22. Peripheral Nerve Block
Techniques:
Ultrasound
Nerve stimulator
Landmark

23. Spinal (A) v Epidural (B)

24. Summary – control of POP

25. General concepts pain treatment

26. General concepts pain treatment
L (ladder) – WHO pain ladder ; stepwise increment of strength of analgesia; start at appropriate level
O (oral) establish oral analgesics ASAP
O (other assoc. symptoms ) Treat N & V, dehydration, constipation, anxiety.

27. Learning Objectives
List 6 important reasons for post operative pain control
Choose appropriate analgesic regimes
Know when to call for senior advice