Acute Pain Management - A Practical Guide

di Macintyre - Schug • 2007 • dettagli prodotto

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DESCRIZIONE

Acute Pain Management: A Practical Guide is intended to give readers a better understanding of the conventional methods of analgesia as well as the more advanced techniques that are now routinely used for the management of acute pain, such as patient-controlled, epidural and continuous regional analgesia. The book explores pain control in more complex patients such as those with acute-on-chronic pain, acute cancer pain or acute pain from a multitude of medical conditions as well as those who are opioid-tolerant have acute neuropathic pain, or are elderly. In addition to new chapters on changes in clinical practice, added to each section are key points that highlight the level of evidence available for that topic. These points have been reproduced with permission from the acute pain guidelines published by the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine, Acute Pain Management: Scientific Evidence - both authors were members of the working party responsible for this document - and annotated according to the system recommended by the National Health and Medical Research Council (NHMRC) of Australia. ContentsINTRODUCTION Effectiveness of acute pain management; Adverse effects of undertreated severe acute pain; Acute pain management and patient outcomesORGANIZATIONAL CONSIDERATIONS: Education Standardization; Acute pain servicesASSESSMENT OF THE PATIENT WITH ACUTE PAIN: Assessment of pain and pain relief; Assessment of adverse effectsPHARMACOLOGY OF OPIOIDS: Mechanisms of action; Effects of opioids; Predictors of opioid dose; Titration of opioid dose; Commonly used opioid agonists; Partial agonists and agonist-antagonists; Opioid antagonistsPHARMACOLOGY OF LOCAL ANESTHETIC DRUGS: Mechanism of action; Efficacy of local anesthetic drugs; Adverse effects of local anesthetic drugs; Commonly used local anesthetic drugsNON-OPIOID AND ADJUVANT ANALGESIC AGENTS: paracetamol (acetaminophen); Non-selective non-steroidal anti-inflammatory drugs; Selective COX-2 inhibitors; Nitrous oxide; NMDA receptor antagonist drugs; alpha 2-Adrenergic agonist drugs; Calcitonin; Antidepressant drugs; Anticonvulsant drugs; Membrane-stabilizing drugsROUTES OF SYSTEMIC OPIOID ADMINISTRATION: Oral route; Intramuscular and subcutaneous routes; Intravenous route; Rectal route; Transdermal route; Transmucosal routesPATIENT-CONTROLLED ANALGESIA: Equipment Analgesic and other drugs used with PCA; The PCA 'prescription'; Requirements for the safe management of PCA; Management of inadequate analgesia; 'Step-down' analgesia; Complications of PCA; Alternative systemic routes of PCA administrationEPIRURAL AND INTRATHECAL ANALGESIA: Anatomy; Contraindications; Drugs used for epidural analgesia; Requirements for the safe management of epidural analgesia; Patient-controlled epidural analgesia; Management of inadequate analgesia; 'Step-down' analgesia; Complications and side effects of epidural analgesia; Concurrent anticoagulant or antiplatelet medications; Intrathecal analgesiaOTHER REGIONAL AND LOCAL ANALGESIA: Continuous peripheral nerve blockade; Intra-articular analgesia; Wound infiltration; Topical analgesiaNON-PHARMACOLOGICAL THERAPIES: Psychological interventions; Transcutaneous electrical nerve stimulation; Acupuncture; Physical interventionsACUTE NEUROPATHIC AND PERSISTENT POSTACUTE PAIN: Pathophysiology of neuropathic pain; Clinical features of neuropathic pain; Acute neuropathic pain syndromes; Treatment of acute neuropathic pain; Progression of acute to persistent pain; Preventive analgesiaNON-SURGICAL ACUTE PAIN: Burns injury; Spinal cord injury; Specific medical conditionsMORE COMPLEX PATIENTS: Elderly patients; Opioid-tolerant patients; Patients with a substance abuse disorder; Patients with obstructive sleep apnea; Pregnant or lactating patients; Patients with renal or hepatic impairmentSELF-ASSESSMENT QUESTIONS