Australian and New Zealand Publication

Practical guide to analgesia and the more advanced techniques now generally used in the management of acute pain.

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. Features key points 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.

Table of Contents

INTRODUCTION

• Effectiveness of acute pain management
• Adverse effects of undertreated severe acute pain
• Acute pain management and patient outcomes

ORGANIZATIONAL CONSIDERATIONS:

• Education Standardization
• Acute pain services

ASSESSMENT OF THE PATIENT WITH ACUTE PAIN:

• Assessment of pain and pain relief
• Assessment of adverse effects

PHARMACOLOGY 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 antagonists

PHARMACOLOGY OF LOCAL ANESTHETIC DRUGS:

• Mechanism of action
• Efficacy of local anesthetic drugs
• Adverse effects of local anesthetic drugs
• Commonly used local anesthetic drugs

NON-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 drugs

ROUTES OF SYSTEMIC OPIOID ADMINISTRATION:

• Oral route; Intramuscular and subcutaneous routes
• Intravenous route
• Rectal route
• Transdermal route
• Transmucosal routes

PATIENT-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 administration

EPIRURAL 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 analgesia

OTHER REGIONAL AND LOCAL ANALGESIA:

• Continuous peripheral nerve blockade
• Intra-articular analgesia
• Wound infiltration
• Topical analgesia

NON-PHARMACOLOGICAL THERAPIES:

• Psychological interventions
• Transcutaneous electrical nerve stimulation
• Acupuncture; Physical interventions

ACUTE 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 analgesia

NON-SURGICAL ACUTE PAIN:

• Burns injury
• Spinal cord injury
• Specific medical conditions

MORE 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 impairment

SELF-ASSESSMENT QUESTIONS

Index