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