painManagementForDummies

- Kutaiba Tabbaa M.D Director Pain Management Clinic University Medical Center Associate Professor of Anesthesia University of Arizona Tucson

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Unformatted text preview: Kutaiba Tabbaa M.D. Director, Pain Management Clinic University Medical Center Associate Professor of Anesthesia University of Arizona Tucson, Arizona What’s the definition of pain? Pain is a Sensory and Emotional experience associated with tissue damage or described in terms of such damage (I.A.S.P.) The Pain Pathways and Mechanisms Pain Pathways Frenchman Rene Descartes, De humine textbook Aß Fibers C Fibers Axon Reflex Np : Neuro-peptides, BV : Blood Vessels Physiology of the dorsal horn of the spinal cord Hyperalgesia And pain Threshold in humans Pain Management in the late 18 th century Barker M.D . Different Pain management Modalities Pre-emptive Analgesia Pre-emptive analgesia can be achieved by: • local anesthetic infiltration of the skin • Effective dose of systemic opioids • Systemic nonsteroidal anti-inflammatory drugs (NSAIDs) • Neuroaxial opioids or local anesthetic • Peripheral nerve blocks Patient Controlled Analgesia PCA 1. Increase patient satisfaction 2. Decrease side effects and complications 3. Decrease sedation 4. Decrease total amount of daily opioids 5. Avoid Basal rate in the Elderly 6. PCA Flowsheets Regional analgesia Isolated Extremity Injury Brachial plexus Anatomy Infraclavicular Approach Infraclavicular Approach Lower Extremity Injury Paravertebral Lumbar Somatic Nerve Block Femoral Nerve Block Sciatic Nerve Block Neuroaxial Blocks Opioid Spread after Epidural injection CSF Circulation Each of the four ventricles of the brain has a choroid plexus and CSF normally circulates between them: 1. The foramen of Monro is an opening from the lateral ventricle into the third ventricle 2. The aqueduct of Sylvius is the pathway of CSF flow between the third and fourth ventricles 3. The foramina (plural of "foramen") of Magendie and Luschka are openings from the fourth ventricle into the subarachnoid space around the base of the brain and upper spinal cord 4. The daily production is around 400-600 ml/ day 5. The reabsorption occurs over the surface of the brain and into the venous dural sinus drainage channels Spread of Opioids in CSF Pharmacokinatics of Epidural injection of Hydrophilic Drug Pharmacokinatics of Epidural Lipophilic Opioid Effects of Increased Pressure on Venous drainage “Pregnancy, Morbid obesity” Complications of Epidural Morphine...
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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- Kutaiba Tabbaa M.D Director Pain Management Clinic University Medical Center Associate Professor of Anesthesia University of Arizona Tucson

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