Author: Jane Ballantyne, M.D.
| Acute Postoperative Pain: Context, Outcomes and Clinical Interventions |
| 21st century medical decision making |
| 15th century medical decision making |
| Quote |
| Acute Postoperative Pain: Context, Outcomes and Clinical Interventions: Slide 5 |
| Articles |
| Randomized controlled trials – 20th century |
| Bandolier |
| Clinical Practice Guideline: Acute Pain Management |
| Advances in acute pain management |
| Advances in acute pain management, cont. |
| Effectiveness of acute postoperative pain management |
| Effectiveness of acute postoperative pain management, cont. |
| Pain relief with different techniques |
| Moderate to severe pain at rest |
| Moderate to severe pain on movement |
| Severe pain |
| Epidurals |
| Local Anesthetics and Opioids |
| Acute Postoperative Pain: Context, Outcomes and Clinical Interventions: Slide 20 |
| Intra-op Post-op |
| Minor morbidity and catastrophic outcome |
| 2005 |
| 2001 |
| 1998 |
| Do epidurals reduce catastrophic outcome? |
| 1987 |
| 2000 |
| 2002 |
| 2001 |
| Accelerated recovery programs
|
| Changes in anesthetic and surgical practice |
| Conclusion |
| PCA |
| PCA Meta-analysis |
| Results of Meta-analysis |
| Acute Postoperative Pain: Context, Outcomes and Clinical Interventions: Slide 37 |
| Acute Postoperative Pain: Context, Outcomes and Clinical Interventions: Slide 38 |
| New technologies |
| Patient-controlled transdermal fentanyl – the evidence |
| Transdermal fentanyl |
| Transdermal fentanyl |
| Patient-controlled, transdermal pain management system |
| Active Transdermal Patch |
| Adjuncts |
| Opioid-sparing: putative advantages |
| Opioid sparing: choice of agents |
| NSAIDs and COX-2 inhibitors |
| Acetaminophen |
| Ketamine |
| Gabapentin and pregabalin |
| Preemptive Analgesia |
| Definition |
| Evolution of pre-emptive analgesia concepts |
| Importance |
| Putative mechanism |
| Central sensitization |
| NMDA receptor role in hyperalgesia |
| Dorsal horn afferent transmitter organization |
| Clinical effects of central sensitization |
| Preemptive analgesia aims to prevent these changes by: |
| Why it doesn’t always work |
| Adequacy of afferent blockade |
| Timing |
| Does it work - the evidence |
| The evidence, cont. |
| The evidence, cont. |
| The evidence, cont. |
| Summary |
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