Post Surgical Pain Case Study
1. Identification of high risk patients for developing choronic post surgical pain:
Preoperative risk factors associated with high incidence of chronic post surgical pain:
• Preoperative pain, not localized to previous nonsurgical site, is strongly related to chronic post surgical pain (Gerbershagen, 2010).
• Intensity and duration of preoperative pain (Katz, 2009).
• Younger female is more prone to having postsurgical pain (Richardson, 2007).
• Excessive fear of surgery has identified as a predictor for postsurgical pain (Peters, 2007).
• Chronic depression is strongly related to postsurgical pain (Hinrichs-Rocker, 2009).
• Stress related physical maninfestations are indication of developin postsurgical pain (Geiss, 2005).
Intraoperative …show more content…
1. Adjuvants are recommended with patient required opioid dosing. The rationale is to reduce side effects associated with opioid use (White, 2005). Some of the most common side effects associated with opioid dosing are 2) inability to carry normal daily activity 2) risk of respiratory depression 3) post operative nausea and vomiting 4) opioid induce hyperalgesia (Mercadante, 2003). The studies have shown that opoid causes hyperalgesia by activating both NMDA and cyclooxygenase nociceptive system (larcher, 1998; Dunbar, 2006).
Adjuvants to be considered are 1) NMDA antagonist (Ketamine; Dextromethorphan, Magnesium, Amantadine 2) Alpha-2 adrenergic agonists (Clonidine, Dexmedetomidine) 3) ANTICONVULSANTS (Gabapentin, Pregabalin); 4) Glucocorticoids (Dexamethasone); 5) Acetylcholine Esterase Inhibitors (Neostigmine) (Buvanendran, 2007).
2. Cognitive Behavior therapy is an adjuvant therapy to be considered (Turk, 2009). The article summarizes the role of pain related fear as a factor to initiate acute pain, subsequent transition of acute pain to chronic pain and thereafter, long term disability of patient depending on the severity of pain. Therefore, the management of psychological issues factoring pain needs to be addressed to prevent the
Preoperative risk factors associated with high incidence of chronic post surgical pain:
• Preoperative pain, not localized to previous nonsurgical site, is strongly related to chronic post surgical pain (Gerbershagen, 2010).
• Intensity and duration of preoperative pain (Katz, 2009).
• Younger female is more prone to having postsurgical pain (Richardson, 2007).
• Excessive fear of surgery has identified as a predictor for postsurgical pain (Peters, 2007).
• Chronic depression is strongly related to postsurgical pain (Hinrichs-Rocker, 2009).
• Stress related physical maninfestations are indication of developin postsurgical pain (Geiss, 2005).
Intraoperative …show more content…
1. Adjuvants are recommended with patient required opioid dosing. The rationale is to reduce side effects associated with opioid use (White, 2005). Some of the most common side effects associated with opioid dosing are 2) inability to carry normal daily activity 2) risk of respiratory depression 3) post operative nausea and vomiting 4) opioid induce hyperalgesia (Mercadante, 2003). The studies have shown that opoid causes hyperalgesia by activating both NMDA and cyclooxygenase nociceptive system (larcher, 1998; Dunbar, 2006).
Adjuvants to be considered are 1) NMDA antagonist (Ketamine; Dextromethorphan, Magnesium, Amantadine 2) Alpha-2 adrenergic agonists (Clonidine, Dexmedetomidine) 3) ANTICONVULSANTS (Gabapentin, Pregabalin); 4) Glucocorticoids (Dexamethasone); 5) Acetylcholine Esterase Inhibitors (Neostigmine) (Buvanendran, 2007).
2. Cognitive Behavior therapy is an adjuvant therapy to be considered (Turk, 2009). The article summarizes the role of pain related fear as a factor to initiate acute pain, subsequent transition of acute pain to chronic pain and thereafter, long term disability of patient depending on the severity of pain. Therefore, the management of psychological issues factoring pain needs to be addressed to prevent the