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101 pages

English

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The importance of effective and safe pain management in the perioperative period has never been greater. The populations clinicians serve are rapidly changing and, when considered in combination with socioeconomic issues, it is clear that the challenges of providing a high-quality perioperative experience are extensive. Fast Facts: Perioperative Pain provides a succinct and accessible guide to the practice of perioperative pain management, covering the complete surgical journey from the preoperative assessment phase through to postoperative management, including persistent postsurgical pain. Packed with detailed figures and illustrations, this valuable resource is suitable for all multidisciplinary team members who encounter surgical patients in pain during the course of their work. Table of Contents: • Pain mechanisms • Preoperative phase • Diagnosis and assessment • Multimodal strategies • Systemic therapies • Non-systemic therapies • Non-pharmacological management • Specific management strategies • Persistent postsurgical pain • Substance use disorder

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Publié par	S. Karger AG
Date de parution	08 avril 2021
Nombre de lectures	0
EAN13	9783318068795
Langue	English
Poids de l'ouvrage	3 Mo

Informations légales : prix de location à la page 0,0005€. Cette information est donnée uniquement à titre indicatif conformément à la législation en vigueur.

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Fast Facts: Perioperative Pain
First published 2021
Text 2021 Matthew Brown, Katherin Peperzak
2021 in this edition S. Karger Publishers Ltd
S. Karger Publishers Ltd, Elizabeth House, Queen Street,
Abingdon, Oxford OX14 3LN, UK
Tel: 44 (0)1235 523233
Book orders can be placed by telephone or email, or via the website.
Please telephone 41 61 306 1440 or email orders@karger.com
To order via the website, please go to karger.com
Fast Facts is a trademark of S. Karger Publishers Ltd.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the express permission of the publisher.
The rights of Matthew Brown and Katherin Peperzak to be identified as the authors of this work have been asserted in accordance with the Copyright, Designs Patents Act 1988 Sections 77 and 78.
The publisher and the authors have made every effort to ensure the accuracy of this book, but cannot accept responsibility for any errors or omissions.
For all drugs, please consult the product labeling approved in your country for prescribing information.
Registered names, trademarks, etc. used in this book, even when not marked as such, are not to be considered unprotected by law.
A CIP record for this title is available from the British Library.
978-3-318-06877-1
Brown M (Matthew)
Fast Facts: Perioperative Pain/
Matthew Brown, Katherin Peperzak
Medical illustrations by Graeme Chambers, Belfast, UK.
Typesetting by Amnet, Chennai, India.
Printed in the UK with Xpedient Print.
This edition has been supported by an independent educational grant from Heron Therapeutics.
For Henry, Amelie and Katharine (MB)
Thank you Chet, Paxton and Parker (KP)
List of abbreviations
Introduction
Pain mechanisms
Preoperative phase
Diagnosis and assessment
Multimodal strategies
Systemic therapies
Non-systemic therapies
Non-pharmacological management
Specific management strategies
Persistent postsurgical pain
Substance use disorder
Useful resources
Index
List of abbreviations
ACT: acceptance commitment therapy
ADD: assessment of discomfort in dementia
AMPA: -amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
ANI: analgesia nociception index
CABG: coronary artery bypass grafting
CIWA: Clinical Institute Withdrawal Assessment for Alcohol
CNPI: checklist of nonverbal pain indicator
COPD: chronic obstructive pulmonary disease
COX: cyclo-oxygenase
CPOT: critical-care pain observation tool
CSE: combined spinal epidural
DSM: Diagnostic and Statistical Manual of Mental Disorders
ECG: electrocardiogram
ERAS: enhanced recovery after surgery
FLACC: face, legs, activity, cry, consolability
GABA: -aminobutyric acid
GFR: glomerular filtration rate
HIV: human immunodeficiency virus
HRV: heart rate variability
IASP: International Association for the Study of Pain
IV: intravenous
MAT: medication-assisted therapy
NAN: nociception-antinociception
NMDA: N -methyl- D -aspartate
NO: nitric oxide
NoL: nociception level (index)
NRS: numerical rating scale
NSAID: non-steroidal anti-inflammatory drug
OBAT: office-based addiction treatment (program)
OUD: opioid use disorder
PCA: patient-controlled analgesia
PCEA: patient-controlled epidural anesthesia
PKC: protein kinase C
PPSP: persistent postsurgical pain
PRD: pupil reflex dilation
PTSD: post-traumatic stress disorder
SAMHSA: Substance Abuse and Mental Health Services Administration
SBIRT: screening, brief intervention and referral to treatment (program)
SUD: substance use disorder
TENS: transcutaneous electrical nerve stimulation
TRPV1: transient receptor potential cation channel subfamily V member 1
VAS: visual analog scale
WMA: western medical acupuncture
Introduction
The importance of effective and safe pain management in the perioperative period has never been greater. The populations we serve as clinicians are rapidly changing, with increases in age, frailty and complexity of comorbidities. When these factors are considered in combination with socioeconomic issues, such as the opioid crisis and budgetary constraint, it is clear that the challenges of providing a high-quality perioperative experience are extensive.
Attention has recently focused on the benefits of ensuring that pain in surgical patients is managed in an effective and compassionate fashion. From reduced postsurgical complications and minimization of hospital length of stay to improved patient satisfaction, these benefits are numerous and multidimensional. There have also been huge advances in the way in which we manage the perioperative pathway, both technical and organizational, as well as greater understanding of the underlying pathophysiology of pain states. Innovation in point-of-care imaging techniques, drug delivery, data science and patient engagement have all incrementally expanded the repertoire of the pain specialist.
Fast Facts: Perioperative Pain provides a succinct and accessible guide to the practice of perioperative pain management, covering the complete surgical journey from the preoperative assessment phase through to postoperative management. Consideration is given to our underlying understanding of the science of acute pain and how to assess it, as well as detailing the approaches –medical and nonmedical – to managing acute pain and the evidence available to support these interventions. In addition, the phenomenon of persistent postsurgical pain is addressed, with an outline of its features, risk factors and potential preventive measures.
We trust that our book will prove a valuable resource for all multidisciplinary team members who encounter surgical patients in pain during the course of their work.
1
Pain mechanisms
The International Association for the Study of Pain (IASP) defines pain as An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. 1 Acute pain as it relates to postoperative care is pain that is temporally related to a specific procedure and expected to reduce during an appropriate period of healing. 2 , 3 Social, cultural and personality factors may affect a patient s perception and response to pain, but generally acute pain responds well to treatment with analgesics and treatments targeted to the precipitating cause.
Pain can be classified in many different ways based on time course, mechanism or etiology ( Table 1.1 ). One common categorization is to differentiate between nociceptive and non-nociceptive pain. 4
Nociceptive pain
Somatic nociceptive pain is typically described as sharp, dull or aching. It is often worsened with movement and improved with rest. It tends to be localized and associated with an underlying lesion.
Specific examples of nociceptive pain include postsurgical pain, musculoskeletal pain and arthritic pain. Visceral nociceptive pain is less well localized and may be described as deep cramping or squeezing pain. It may be associated with autonomic sensations such as nausea, vomiting and diaphoresis. Patterns of pain referral exist, such as shoulder pain produced by diaphragmatic irritation following laparoscopic surgery. 5
Mechanistically, nociceptive pain begins with a noxious stimulus (mechanical, thermal or chemical) that activates peripheral nociceptors and sends impulses along myelinated Aδ and unmyelinated C fibers to the spinal cord. These fibers synapse in the dorsal horn of the spinal cord before ascending to the thalamus, hypothalamus, reticular system and cortex of the brain, where the emotional and stress responses to pain are regulated ( Figure 1.1 ).

TABLE 1.1
Potential ways of classifying pain
Time course Acute (<3 months) Subacute ( 6 weeks,<3 months) Chronic ( 3 months) Episodic
Etiology Cancerous Ischemic Postoperative Injury Cross-talk between sympathetic and sensory neurons
Type of injured tissue Nociceptive Neuropathic Visceral Somatic
Intensity Mild Moderate Severe
Inferred mechanism Tissue damage Inflammation Central sensitization of nociceptors Nerve-damage-triggered neuroplasticity changes Brain neuroplasticity changes Loss of inhibition Glia-derived neural sensitization
In general, postoperative pain includes at least some component of nociceptive pain, as the nervous system is perceiving tissue damage from the procedure itself or an injury prompting a procedure to be performed. 6 , 7
Potentiation. Following tissue or nerve damage, central potentiation occurs when peripheral nociceptors become sensitized in response to the accumulation of various endogenous chemicals and inflammatory mediators, such as bradykinin, prostaglandins, histamine and interleukins ( Figure 1.2 ). As pain persists, this sensitization and heightened afferent activity leads to chemical and anatomic reorganization in the spinal cord itself. In turn, this may lead to long-term central potentiation characterized by exaggerated responses to afferent impulses and an increased perception of pain (also known as nociplastic pain or pain that arises from altered nociception despite no actual or potential tissue damage).

Figure 1.1 Nociceptive pathways. Nociceptive pain does not rely solely on passive transduction of pain signals; it also involves complex processing resulting in