· Premise
· Acute pain service
· Acute pain consult
· Analgesics
· Red flag groups
· Patients have a right to pain relief
· Good pain relief is good for the mind and body (and reduces risk of chronic pain)
· Good pain relief frees up beds for the hospital and saves money
· Analgesics can be dangerous if inappropriately prescribed
· Complex regimens require an Acute Pain Service
*Multi-disciplinary approach*: home team, pharmacist, physio, psychology
Staff |
· Anaesthetists and trained nurses |
Policies |
· For treatment and monitoring |
Services |
· Daily review · Consults and referrals · Discharge planning |
Quality assurance |
· Rrecord keeping, audit |
Education |
· Medical students · Ward nurses · Residents |
Research |
|
Assessment |
· Type of pain: somatic vs neuropathic · Severity of pain: o Subjective (score, function) vs objective (appearance, vital signs) o Rest vs activity o If out of proportion: suspect new diagnosis · Suitable for oral route? · Side effects? · Complications? (especially if epidural) |
Education |
· Patient + family: expectations, goals · Treating nurse |
Plan/suggestion |
· Discuss with home team · Discuss with treating nurse |
Principles |
· Multi-modal · Individualised doses · Titration to effect |
Non-drug |
· Physical therapy · Cognitive behavioural therapy · Other: TENS, acupuncture etc |
Oral drugs |
· Paracetamol · NSAIDs, COX-2 inhibitors · Oxycodone, morphine · Tramadol, tapentadol · Clonidine · Gabapentinoids |
IV infusions* |
· Opioid PCA · Ketamine infusion |
Local anaesthetic* |
· Neuraxial · Regional · Subcut |
*Requires APS input
Risk of over-doing it |
· Pregnant (also teratogenicity) · Child · Obese · OSA |
Risk of under-doing it |
· Chronic pain · Opioid tolerant · Substance abuse |
Difficulty communicating |
· Cognitive impairment · Non-English speakers · Aborigines |
Feedback welcome at ketaminenightmares@gmail.com