Perioperative pain management in the paediatric population: what about outcome?? Kris vermeylen
|
|
- Lillian Lawson
- 5 years ago
- Views:
Transcription
1 Perioperative pain management in the paediatric population: what about outcome?? Kris vermeylen
2
3 Perioperative pain management Introduction Physiology Therapeutic possibilities Conclusion THM
4 Introduction
5 Evidence regarding the efficacy of analgesics available to guide postoperative treatment in paediatric patients is limited few evidence-based reports are available to guide the use of opioid medications in children
6 the majority of pain medications available on the market today are unlabeled for use in pediatric patients lack of adequate research
7 Pain in children : unrecognized poorly treated under-prescribed under-dosed for opioid and non-opioid analgesics unwarranted concerns of respiratory depression and/or poor understanding of the need for pain medications in children
8 A child is not an adult
9 Paediatric physiology Circulation Ventilation Central nervous system Metabolism Temp regulation
10 Paediatric physiology Circulation Ventilation Central nervous system Metabolism Temp regulation
11 Central nervous system Incomplete myelinisation BBB is incomplete: increased sensitivity for stimuli Parasympathic system >> Sympathic system : increased vagal tonus: bradycardia!! Higher sensitivity for pain: pain at young age can give lower pain thresholds (at that age) and therefore higher pain responses when adult
12 Central nervous system Immature neuromuscular transmission Amount of Acetylcholine is limited Train of 4 : often only 3 answers Foetal form of nicotine receptors (replaced in the first weeks after birth to mature ones)
13 Liver: immature Metabolism Lower plasma-lipid fraction: lipid binding decreased: higher med free fraction Kidney function immature: lower excretion rate
14 Good pain management is crucial
15 Different sources of pain Acute pain Trauma Postoperative Other Chronic pain Postoperative Other
16 What do we do? Therapeutic possibilities
17 Acute pain management
18 protocols for the recognition and treatment of pain for children during their perioperative stay Standardizing pain measurements require the use of appropriate pain scales. There are many pain scales available, all of which have advantages and disadvantages. It is not so important which of these pain scales is used, but that they are used on a consistent basis.
19 Pain Scores
20 Pain scores in children What do we look for? Physiological changes: acute pain! HR and RR changes BP changes Pupil dilatation Nausea Transpiration Behaviour changes
21 Pain scores in children
22 Pain scores in children Name of Type Description Age Group Scale Numeric (0-10 Scale) Self-Report Verbal 0-10 scale; 0 = no pain, 10 = worst pain you could ever imagine Children who understand the concept of numbers, rank, and order. Approximately > 8 yrs Bieri Faces Self-Report 6 faces that range from no pain to the worst pain you can imagine. See Appendix 1 Younger children who have difficulty with numeric scale. Cognitive age 3-7 FLACC CRIES, NIPS, PIPP Behavioral Observer Behavioral Observer 5 categories: face, legs, activity cry and consolability. Range of total score is Score 7 is severe pain. See Appendix 1 Rates a set of standard criteria and gives a score. years. Non-verbal children > 1 year of age Non-verbal infant < 1 year of age.
23 Pain scores in children Bieri Faces Pain Scale-Revised
24 Pain scores in children FLACC Pain Assessment Tool Categories Score 0 Score 1 Score 2 Face Legs No particular expression or smile Normal position or relaxed Occasional grimace or frown, withdrawn, disinterested Uneasy, restless, tense Frequent to constant frown, clenched jaw, quivering chin Kicking, or legs drawn up Activity Cry Consolability Lying quietly, normal position, moves easily No cry (awake or asleep) Content, relaxed Squirming, shifting back and forth, tense Moans or whimpers, occasional complaint Reassured by occasional touching, hugging, or being talked to, distractible Arched, rigid, or jerking Crying steadily, screams or sobs, frequent complaints Difficult to console or comfort
25 Pain scores in children: cheops
26
27 Medication
28 Pain ladder
29 PCA dosing recommendations Table 2: PCA dosing recommendations Morphine Fentanyl Hydromorphone Solution 1 mg/ml Solution mg/ml or Initial dose mcg/kg (max 1.5mg) mcg/ml 0.25mcg/kg 1mg/ml 3-4mcg/kg (max 0.3mg) Lockout time 8-10 minutes 8-10 minutes 8-10 minutes Basal infusion Maximum starting dose 0-20mcg/kg- /hr 100mcg/kg/- hr 0-1mcg/kg/hr 0-4mcg/kg/hr 1-2mcg/kg/hr 20mcg/kg/hr
30 Problems with systemic analgesics Many drugs are still used off label Little characterized efficacy and safety profile in children Little scientific background Studies are considered unethical Problems with informed consent Validated endpoints to measure efficacy
31 Is it possible to treat pain without opioids?
32 Alternatives Combinations of non-opioid analgesics in multimodal approach NSAIDs in combi with acetaminophen Tramadol in combi with acetaminophen Bethamethasone, clonidine, Regional anaesthesia Lam DK, Corry GN, Tsui BC. Evidence for the use of ultrasound imaging in pediatric regional anesthesia: a systematic review. Reg Anesth Pain Med 2016; 41: Guay J, Suresh S, Kopp S. The use of ultrasound guidance for perioperative & neuraxial and peripheral nerve blocks in children: a Cochrane review. Anesth Analg 2017; 124:
33 Regional anaesthesia
34 Regional anaesthesia and paediatrics : does it match? Lam DK, Corry GN, Tsui BC. Evidence for the use of ultrasound imaging in anaesthesia: a systematic review. Reg Anaesth Pain Med 2016; 41: paediatric regional Guay J, Suresh S, Kopp S. The use of ultrasound guidance for perioperative & neuraxial and peripheral nerve blocks in children: a Cochrane review. Anesth Analg 2017; 124:
35 Long history of RA and kids Dr. August Bier performed in 1898 the first RA blocks in modern Anaesthesia intraspinal injections of cocaine -> 5 of his first 10 patients were children
36 Literature Long history of paediatric regional anaesthesia Evidence in literature: lots of advantages Reduced stress response Better postoperative analgesia Less opioid related side-effects Early extubation therefore, a local technique should be used for all operations unless contraindicated S Roberts, Review article, Utrasonographic guidance in pediatric regional anesthesia, Pediatric Anesthesia 2006, 16,
37 Regional anaesthesia techniques providing an excellent intra- and post-operative analgesia have become an extremely important part of paediatric anaesthesia Markakis D.A. Regional anesthesia in pediatrics. Anesthesiol Clin North America, 2000;18: Dalens B. in Regional anesthetic Techniques in Pediatric anesthesia. B. Bissonnette and B. Dalens, Eds. 2002, McGraw Hill:
38 Regional anaesthesia: mechanism
39 Regional anaesthesia: Awake or asleep? 90% of the RA techniques are under GA supported by the pediatric anaesthesiologists world wide Krane E.J., The safety of epidurals placed during general anesthesia [editorial]. Reg Anesth Pain Med, (5): p Taenzer A et al. Asleep vs Awake: Does it matter?reg Anesth Pain Med 2014;39:
40 Common paediatric RA techniques Penile block Caudal block Ilioingiunal block Femoral block. all adult blocks can be performed on children
41 Neuraxial anaesthesia
42 Epidural dosing cont. infusion Agents Concentration Infusion Bupivacaine % cc/kg/hr Bupivacaine / Fentanyl % / 2-4 ug/cc cc/kg/hr Fentanyl 2-5 ug/cc ug/kg/hr Morphine (PF) ug/cc 2-10 ug/kg/hr Hydromorphone 10 ug/cc 1-3 ug/kg/hr 1) The maximum infusion rates should not exceed 0.5 mg/kg /hr of bupivacaine in
43 Epidural dosing PCEA Bupivacaine plus fentanyl Solution 0.75mg/ml bupivicaine + 5 mcg/ml fentanyl Initial dose 0. 1ml/ kg/ dose Lockout time minutes Basal infusion 0.2ml/kg/hr (max 9.9ml/hr) Maximum dose 0.4ml/kg/hr
44 Peripheral nerve blocks
45 Role of US
46 Peripheral vs neuraxial extremely low incidence of complications after peripheral nerve blocks!! In favor in comparison with neuraxial blocks due to good visualisation of the nerves and the surrounding structures Giaufre E et al. Anesth Analg 1996; 83: Berde C et al. Anesth Analg 1996; 83: Llewellyn N et al. Paediatric Anaesth 2007;17: Taenzer A et al. Reg Anesth Pain Med 2014;39:
47 dose reduction Van Geffen et al. Ultrasound-guided bilateral continuous sciatic nerve bloks with stimulating catheters for postoperative pain relief after bilateral lower limb amputations. Anesthesia 2006;61:
48 Peripheral vs neuraxial: or the combination!! Acta Anaesthesiol Belg. 2011;62(3): Ultrasound as guidance for a combined bilateral supraclavicular and caudal block, in order to reduce the total anaesthetic dose in a two year old child after a pneumococcal sepsis. Vermeylen K, Berghmans J, Van de Velde M, De Leeuw T, Himpe D.
49 Supraclavicular plexus in 2 year old
50
51
52 USG Caudal block dose reduction transverse axis view on the lower lumbar level (view on the intervertebra level L4L3) : ultrasound confirmation of the caudal block, LA=local anaesthetic, CSF=cerebrospinal-fluid, dura is pushed to anterior as result of the local anaesthetic
53 Continuous fascia iliaca compartment block in children: a prospective evaluation of plasma bupivacaine concentrations, pain scores, and side effects. Anesth Analg May;92(5): Paut O, Sallabery M, Schreiber-Deturmeny E, Rémond C, Bruguerolle B, Camboulives J. Abstract We sought to determine the plasma concentrations of bupivacaine and its main metabolite after continuous fascia iliaca compartment (FIC) block in children. Twenty children (9.9 +/- 4 yr, 38 +/- 19 kg) received a continuous FIC block for either postoperative analgesia (n = 16) or femoral shaft fracture (n = 4). A bolus dose of 0.25% bupivacaine (1.56 +/- 0.3 mg/kg) with epinephrine was followed by a continuous administration of 0.1% bupivacaine ( / mg. kg(-)(1). h(-)(1)) for 48 h. Plasma bupivacaine levels were determined at 24 h and 48 h by using gas liquid chromatography. Heart rate, arterial blood pressure, respiratory rate, side effects, and pain scores were recorded at 4-h intervals during 48 h. No significant differences were found between mean plasma bupivacaine levels at 24 h (0.71 +/- 0.4 microg/ml) and at 48 h (0.84 +/- 0.4 microg/ml) (P = 0.33). FIC block provided adequate analgesia in most cases. No severe adverse effects were noted. We conclude that the bupivacaine plasma concentrations during continuous FIC block in children are within the safety margins. FIC block is well tolerated, and provides satisfactory pain relief in most cases. IMPLICATIONS: In this study, we have shown that, in children, continuous fascia iliaca compartment block, a technique providing neural blockade of the thigh and the anterior part of the knee, was associated with safe plasma bupivacaine concentrations, was well tolerated, and provided satisfactory pain scores in most cases.
54 Chronic paediatric pain
55 Can we predict patients at risk?? Post surgical pain = pain > 3 months postop Prevalence up to 20% after 12 months of surgery Determined by severity of acute postoperative pain in the first 24 hours after surgery (VAS>3) Related to dermatome Can be after an asymptomatic period Treede RD, Rief W, Barke A, et al. A classification of chronic pain for ICD-11. Pain ; 156: Lavand homme P. Why me? The problem of chronic pain after surgery. Br J && Pain 2017; 11: Outstanding review on chronic postsurgical pain (CPSP). Rabbitts JA, Fisher E, Rosenbloom BN, Palermo TM, et al. Prevalence and & predictors of chronic postsurgical pain in children: a systematic review and meta-analysis. J Pain 2017; 18: Undated Meta-analysis on the predictors of CPSP in children and adolescents. Batoz H, Semjen F, Bordes-Demolis M, et al. Chronic postsurgical pain in children: prevalence and risk factors. A prospective observational study. Br J Anaesth 2016; 117:
56 Chronic Pain Management The multidisciplinary approach is standard of care for treating chronic pain in children. All children evaluated for chronic pain should be seen by all primary members of the team on their initial visit. Multidisciplinary pain team include: pain physician, pediatric psychologist psychitatrist, OT/PT, APN s, social worker.
57 Chronic Pain Management Pediatric pain physicians cross many specialties but most commonly they are anesthesiologists, rheumatologists, or neurologists without formal training in pediatric pain. Although, multiple approaches exist in caring for these patients the most successful programs base their approach on combined intensive rehabilitation and intensive psychotherapy relying minimally on invasive procedures and pharmacotherapy.
58 Conclusions
59 Future research Clinical trials are needed to evaluate the safety and efficacy of analgesics across all pediatric age spans to avoid inappropriate extrapolation of adult data to children.
60 Conclusions Treatment options have evolved in recent years Using combinations of nonopioid analgesics and multimodal approach may limit need for opioids Combinations of multimodal regimens and regional anaesthesia
61 Conclusions US guided RA!!
Palliative Care. And Pain Management
Palliative Care And Pain Management Revised: bw/september 2010 Palliative Care Symptom management is a primary goal of palliative care. Pain is one of the most feared symptoms experienced by patients.
More informationPain relief for children
Pain relief for children Inpatient Pain Team Parent/carer Information Leaflet Introduction At The Dudley Group we aim to give your child good pain relief and make them as comfortable as possible after
More informationGeneral Medical: Pain Management
General Medical: Pain Management Goals: Provide prompt, effective and safe pain relief due to a wide variety of acute injuries and medical illnesses commensurate with pain severity and patient s hemodynamic
More informationFunding: National Children s Research Centre, Ireland ISRCTN & EudraCT no
Severe Sickle Cell PaiN Intranasal Fentanyl (SSNIF) versus Intravenous Morphine - A Placebo-Controlled, Triple-Blind, Double-Dummy Non-Inferiority Randomized Controlled Trial Michael Joseph Barrett 1,2,3,
More informationAnnual Pain Competency
Annual Pain Competency 2016 Revised for RBMC Please call Professional Development at X4196 or X5947 if you have any questions The learner will be able to: Objectives Explain pain scales & appropriate use
More informationSedation and Analgesia in the Critically Ill
12th Congress of the World Federation of Societies of Intensive and Critical Care Medicine August 29 (Sat.) September 1 (Tue.), 2015 COEX, Seoul, Korea ONE STEP FURTHER: THE PURSUIT OF EXCELLENCE IN CRITICAL
More informationIshrat Rashid 1, Khairat Mohammad 2, Mohamad Ommid 3, Mubasher Ahmad 4, Sheikh Irshad 5,Velayat Nabi 6
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 9, Issue 2 (Jul.- Aug. 2013), PP 42-48 A prospective randomized double blind Study of the effects of
More informationCounty Alameda Public Health Department Emergency Medical Services Division. Trial Study The Prehospital Use of Fentanyl.
County Alameda Public Health Department Emergency Medical Services Division Trial Study The Prehospital Use of Fentanyl 18 Month Report March 24, 2009 TABLE OF CONTENTS Introduction... 1 Methods... 2 Data
More informationTarek M Sarhan, Assistant professor of Anesthesiology, Faculty of Medicine, Alexandria University
7 ANALGESIA FOR TRACHEOESOPHAGEAL FISTULA REPAIR IN NEONATES : A COMPARISON OF SINGLE SHOT THORACIC PARAVERTEBRAL BLOCK AND EPIDURAL BLOCK WITH ROPIVACAINE Tarek M Sarhan, Assistant professor of Anesthesiology,
More informationPain in the Pediatric Population
Objective Pain in the Pediatric Population Noor Daghistani, Pharm.D. Define and discuss types of Discuss barriers in the treatment of in the pediatric population Describe age appropriate strategies and
More informationEffective Postoperative Pain Management for Children. Nancy L. Glass, MD, MBA,
Effective Postoperative Pain Management for Children Nancy L. Glass, MD, MBA, FAAP nglass@bcm.edu @DrNancyGlass1 None Disclosures Learning Objectives At the end of this presentation, participants will
More informationDeb Gordon RN, DNP, FAAN Nursing Orientation
Deb Gordon RN, DNP, FAAN Nursing Orientation debrag3@uw.edu 1 Introduce & Discuss: HMC policy overview Pain screening, assessment, reassessment IV PCA, Epidural, PNC analgesia Pain Relief Service Joint
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article A Study to Evaluate the Effectiveness of Cartoon Based Diversional Therapy on Pain during Intravenous
More informationDrug Administration Document for Babies, Children and Young People Requiring Symptom Management
Drug Administration Document for Babies, Children and Young People Requiring Symptom Management Patients Name: Address: GP: of Birth: NHS : Weight, Location & : Known Allergies: of Known Allergies: Allergy
More informationEffect of Kaleidoscope on Pain Perception of Children Aged 4-6 Years During Intravenous Cannulation
American Journal of Nursing Science 2018; 7(4): 137-142 http://www.sciencepublishinggroup.com/j/ajns doi: 10.11648/j.ajns.20180704.14 ISSN: 2328-5745 (Print); ISSN: 2328-5753 (Online) Effect of Kaleidoscope
More informationName of Child: Date: About Pain
Procedure/Treatment/Home Care Si usted desea esta información en español, por favor pídasela a su enfermero o doctor. #472 Name of Child: Date: About Pain Pain is part of life. We all get bumps and bruises.
More informationSafe and Evidence Based Perioperative Pain Management in an Opioid-Dependent Child Undergoing Lower Extremity Amputation for Necrotizing Fasciitis
Safe and Evidence Based Perioperative Pain Management in an Opioid-Dependent Child Undergoing Lower Extremity Amputation for Necrotizing Fasciitis International Assembly for Pediatric Anesthesia 2012 Moderator:
More informationWHAT IS PAIN? PEDIATRIC PAIN: NOT JUST A FACE ON A SCALE LEARNING OBJECTIVES
PEDIATRIC PAIN: NOT JUST A FACE ON A SCALE Erin Davis, M.S., OTR/L FOTA Conference November 7, 2015 1 LEARNING OBJECTIVES 2 Recognize the prevalence of pediatric pain and its impact on function Identify
More informationAnalgesia in Children in the Emergency Department
Top of Form Analgesia in Children in the Emergency Department INTRODUCTION Pain is the commonest presenting symptom in patients attending Emergency Departments (EDs). There is definitive evidence that
More informationPain Assessment in Children
Pain Assessment in Children Professor Alison Twycross Head of Department for Children s Nursing September 2016 Learning outcomes By the end of the session participants will: Be able to describe the different
More informationObjectives. Objectives 9/11/2012. Chapter 07. Fluids and Medications
Chapter 07 Fluids and Medications Objectives Define the following terms: chronotrope, dromotrope, and inotrope. Identify the primary neurotransmitter for the sympathetic and parasympathetic divisions of
More informationIntraspinal (Neuraxial) Analgesia Community Nurses Competency Test
Intraspinal (Neuraxial) Analgesia Community Nurses Competency Test 1 Intraspinal (Neuraxial) Analgesia for Community Nurses Competency Test 1) Name the two major classifications of pain. i. ii. 2) Neuropathic
More informationObjectives. Conflict of Interest Disclosure. Neuraxial and Regional Anesthesia in the Pediatric Population
Neuraxial and Regional Anesthesia in the Pediatric Population Lauren Renner, MS, RN-BC, PNP Sharon Wrona, DNP, RN-BC, PNP, PMHS, AP- PMN.... Conflict of Interest Disclosure Conflicts of Interest for ALL
More informationIAEM Clinical Guideline 2 Emergency Department Analgesia in Children
IAEM Clinical Guideline 2 Emergency Department Analgesia in Children Version 1 July 2013 DISCLAIMER IAEM recognises that patients, their situations, Emergency Departments and staff all vary. These guidelines
More informationRegional anaesthesia in paediatric day case surgery. PA Lönnqvist Karolinska Institutet Karolinska University Hospital Stockholm, Sweden
Regional anaesthesia in paediatric day case surgery PA Lönnqvist Karolinska Institutet Karolinska University Hospital Stockholm, Sweden Ambulatory surgery in children Out-patient surgery in children did
More informationNEW KIDS ON THE BLOCK: THE NEW ERA OF REGIONAL ANESTHESIA PLANE BLOCKS
2017 CSA Fall Anesthesia Conference NEW KIDS ON THE BLOCK: THE NEW ERA OF REGIONAL ANESTHESIA PLANE BLOCKS Michael Barrington, MB BS, FANZCA, PhD Senior Staff Anaesthetist, St Vincent s Hospital, Melbourne.
More informationRegional Anaesthesia for Children
Regional Anaesthesia for Children Indispensable! but also safe? PD Dr. med. Jacqueline Mauch Outline Significance of regional anaesthesia in paediatric surgery Risks and complications of regional anaesthesia
More informationPractice Advisory on Pediatric Regional Anesthesia:
ESRA/ASRA Joint Committee: Practice Advisory on Pediatric Regional Anesthesia: Giorgio Ivani Regina Margherita Children s Hospital Turin Italy gioivani@libero.it Why? Obsolete? Advances in Anesthesia
More informationBladder exstrophy-epispadius complex. An overview of anaesthetic management
Bladder exstrophy-epispadius complex. An overview of anaesthetic management S. R. Engineer, N. B. Solanki Department of Anesthesia, B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India Corresponding
More informationA Staged Approach to Analgesia After Hip Arthroscopy Using Multimodal Analgesia & Elective Ultrasound Guided Fascia Iliaca Block
A Staged Approach to Analgesia After Hip Arthroscopy Using Multimodal Analgesia & Elective Ultrasound Guided Fascia Iliaca Block James T. Beckmann MD Stephen K. Aoki MD Stephen Guyette MD Jeffrey Swenson
More informationSystem Patient Care Services
North Shore-LIJ Health System is now Northwell Health System Patient Care Services POLICY TITLE: Pain Management: Assessment and Reassessment POLICY #: PCS.1603 System Approval Date: 10/20/16 CLINICAL
More informationENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT
ENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT Jeff Gadsden, MD, FRCPC, FANZCA Associate Professor Duke University Department of Anesthesiology Regional Anesthesia and Acute Pain Medicine DISCLOSURES
More informationAnaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation
Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation Dr Ajay Kumar Senior Lecturer Macquarie and Melbourne University Introduction Amputee
More informationMEASURING, MANAGING AND MITIGATING CANCER AND TREATMENT PAIN IN INFANTS: Pharmacology
MEASURING, MANAGING AND MITIGATING CANCER AND TREATMENT PAIN IN INFANTS: Pharmacology Jason T Maynes, PhD/MD Wasser Chair in Anesthesia and Pain Medicine Associate Chief of Perioperative Services (Research)
More informationCurrent evidence in acute pain management. Jeremy Cashman
Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side
More informationENA: EMERGENCY NURSING ORIENTATION
ENA: EMERGENCY NURSING ORIENTATION Lesson Notebook: Pain Lesson Outline Key Resources Preceptor Exercise LESSON OUTLINE Definitions and Classification of Pain Pain is whatever the person experiencing it
More informationBalanced Analgesia With NSAIDS and Coxibs. Raymond S. Sinatra MD, Ph.D
Balanced Analgesia With NSAIDS and Coxibs Raymond S. Sinatra MD, Ph.D Prostaglandins and Pain The primary noxious mediator released from damaged tissue is prostaglandin (PG) PG is responsible for nociceptor
More informationCAESAREAN SECTION Brian Fredman
CHAPTER 3 GYNAECOLOGICAL SURGERY CAESAREAN SECTION Brian Fredman Review of evidence: surgical site infusion Of the seven studies on surgical site local anaesthetic infusion after Caesarean section performed
More informationShow Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital
Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine
More informationPediatric epidural analgesia (PEA)
Pediatric Anesthesia ISSN 1155-5645 REVIEW ARTICLE Pediatric epidural analgesia (PEA) Anthony Moriarty Birmingham Children s Hospital NHS Foundation Trust, Birmingham, UK Keywords acute; pain; regional;
More informationAwake regional versus general anesthesia in preterms and ex-preterm infants for herniotomy
Awake regional versus general anesthesia in preterms and ex-preterm infants for herniotomy Department of Anaesthesia University Children s Hospital Zurich Switzerland Epidemiology Herniotomy needed in
More informationLearning Objectives. Perioperative goals. Acute Pain in the Chronic Pain Patient for Ambulatory Surgery 9/8/16
Acute Pain in the Chronic Pain Patient for Ambulatory Surgery Danielle Ludwin, MD Associate Professor of Anesthesiology Division of Regional and Orthopedic Anesthesia Columbia University Medical Center
More informationComparison Of 0.5%Bupivacaine And 0.5% Bupivacaine Plus Buprenorphine in Brachial Plexus Block
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 1 Ver. VIII (Jan. 2016), PP 01-08 www.iosrjournals.org Comparison Of 0.5%Bupivacaine And 0.5%
More informationRole and safety of epidural analgesia
Anaesthesia for Liver Resection Surgery The Association of Anaesthetists Seminars 21 Portland Place, London Thursday 15 th December 2005 Role and safety of epidural analgesia Lennart Christiansson MD,
More informationPerioperative Pain Management
Perioperative Pain Management Overview and Update As defined by the Anesthesiologist's Task Force on Acute Pain Management are from the practice guidelines from the American Society of Anesthesiologists
More informationNeostigmine as an adjunct to Bupivacaine, for caudal block in burned children, undergoing skin grafting of the lower extremities
Neostigmine as an adjunct to Bupivacaine, for caudal block in burned children, undergoing skin grafting of the lower extremities Dr. Pramod Gupta, Dr Amy Grace MD Department of Anaesthesiology and Critical
More informationPaediatric Anaesthesia Formulas
Paediatric Anaesthesia Formulas Fluid requirements Fasting Guidelines for Pediatric Patients TYPE Fasting Time (hr) Clear liquids* 2 Breast milk 4 TYPE Infant formula 6 Solid (fatty or fried) foods 8 Fasting
More informationSafety of Pediatric Regional Anesthesia. Arjunan Ganesh The Children s Hospital of Philadelphia
Safety of Pediatric Regional Anesthesia Arjunan Ganesh The Children s Hospital of Philadelphia Disclosure Nothing related to this presentation Objectives Understand the current ASRA/ESRA Practice Advisory
More informationAbstract. Keywords. Comparing midazolam-bupivacaine and neostigmine-bupivacaine for caudal anesthesia in children undergoing herniorrhaphy
Comparing midazolam-bupivacaine... Original 71 Comparing midazolam-bupivacaine and neostigmine-bupivacaine for caudal anesthesia in children undergoing herniorrhaphy Ahmad Khaleghnejad Tabari 2 Afsaneh
More informationGUIDELINES ON PAIN MANAGEMENT IN UROLOGY
GUIDELINES ON PAIN MANAGEMENT IN UROLOGY F. Francesca (chairman), P. Bader, D. Echtle, F. Giunta, J. Williams Eur Urol 2003; 44(4):383-389 Introduction Pain is defined as an unpleasant sensory and emotional
More informationSonoma Valley Hospital Sonoma Valley Healthcare District Policy and Procedure Organizational. Page: 1
Title: PAIN MANAGEMENT Sonoma Valley Hospital Organizational Number: PC-104 Page: 1 Effective Date: 3/96 Mary Kelly, R.N., M.P.A. 12/07 Approved By Date Revision Dates: 07/01, 02/02 Signature on file Signature
More informationThe intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia
The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia This study has been published: The intensity of preoperative pain is directly correlated
More informationPAIN MANAGEMENT. Region Orientation. October 2010
PAIN MANAGEMENT Region Orientation October 2010 1 DEFINITION OF PAIN Pain is whatever the experiencing person says it is, existing when and where it is and not what others think it ought to be. Total Pain
More informationRegional Anesthesia. procedure if required. However, many patients prefer to receive sedation either during the
1 Regional Anesthesia Regional anaesthesia (or regional anesthesia) is anesthesia affecting only a large part of the body, such as a limb or the lower half of the body. Regional anaesthetic techniques
More informationAssistant Professor, Anaesthesia Department, Govt. General Hospital / Guntur Medical College, Guntur, Andhra Pradesh, India.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 8 Ver. I (August. 2016), PP 87-91 www.iosrjournals.org A Comparative Study of 0.25% Ropivacaine
More informationLabor Epidural: Local Anesthetics and Beyond
Goals: Labor Epidural: Local Anesthetics and Beyond Pedram Aleshi MD The Changing Practice of Anesthesia September 2012 Review Concept of MLAC Local anesthetic efficacy Local anesthetic sparing effects:
More informationGUIDELINES FOR PERIPHERAL NERVE / PLEXUS BLOCK CATHETER MANAGEMENT DEPARTMENT OF ANAESTHESIOLOGY AND INTENSIVE CARE HOSPITAL KUALA LUMPUR
GUIDELINES FOR PERIPHERAL NERVE / PLEXUS BLOCK CATHETER MANAGEMENT DEPARTMENT OF ANAESTHESIOLOGY AND INTENSIVE CARE HOSPITAL KUALA LUMPUR INTRODUCTION Regional block provides superior pain relief, compared
More informationPAIN MANAGEMENT IN UROLOGY
24 PAIN MANAGEMENT IN UROLOGY F. Francesca (chairman), P. Bader, D. Echtle, F. Giunta, J. Williams Eur Urol 2003; 44(4):383-389 Introduction Pain is defined as an unpleasant sensory and emotional experience
More informationEpidural Analgesia: The Best Mix
Epidural Analgesia: The Best Mix Clinical Associate Professor Nolan McDonnell FANZCA MClinRes Department of Anaesthesia and Pain Medicine King Edward Memorial Hospital for Women Subiaco, Western Australia
More informationSEEING KETAMINE IN A NEW LIGHT
SEEING KETAMINE IN A NEW LIGHT BobbieJean Sweitzer, M.D., FACP Professor of Anesthesiology Director of Perioperative Medicine Northwestern University Bobbie.Sweitzer@northwestern.edu LEARNING OBJECTIVES
More informationThe prophylactic effect of rectal diclofenac versus intravenous pethidine on postoperative pain after tonsillectomy in children
Saleh and Hassan Ain-Shams Journal of Anesthesiology (2019) 11:1 https://doi.org/10.1186/s42077-018-0017-3 Ain-Shams Journal of Anesthesiology ORIGINAL ARTICLE Open Access The prophylactic effect of rectal
More informationPost-operative Analgesia for Caesarean Section
Post-operative Analgesia for Caesarean Section Introduction Good quality analgesia after any surgery leads to earlier mobilisation, fewer pulmonary and cardiac complications, a reduced risk of DVT and
More informationBANGASH L.R., AFZAL F., HUSSAIN S. AND ALI K. Department of Anaesthesia, King Edward Medical University / Mayo Hospital, Lahore, Pakistan
D:\Biomedica Vol. 30, Issue 4, Oct. Dec., 2014\Bio-2.Doc P. 267 271 (KC) III ORIGINAL ARTICLE COMPARISON OF CAUDAL BLOCK ALONE WITH CAUDAL BLOCK PLUS INTRAVENOUS DEXAMETHASONE FOR POSTOPERATIVE ANALGESIA
More informationSTARSHIP WITHDRAWAL OF ANALGESIA AND SEDATION
STARSHIP WITHDRAWAL OF ANALGESIA AND SEDATION Patients receiving analgesia and/or sedation for longer than 5-7 days may suffer withdrawal if these drugs are suddenly stopped. To prevent this happening
More informationAnesthesia for Total Hip and Knee Arthroplasty
Anesthesia for Total Hip and Knee Arthroplasty Typical approach Describe anesthesia technique Rather Describe issues with THA and TKA How anesthesia can modify Issues Total Hip Total Knee Blood Loss ++
More informationParaspinal Blocks a new paradigm in truncal analgesia
Paraspinal Blocks a new paradigm in truncal analgesia Ki Jinn Chin, MBBS (Hons), MMed, FRCPC Associate Professor Toronto Western Hospital University of Toronto Online Resources https://youtu.be/lockhd
More informationDORIS DUKE MEDICAL STUDENTS JOURNAL Volume V,
Continuous Femoral Perineural Infusion (CFPI) Using Ropivacaine after Total Knee Arthroplasty and its Effect on Postoperative Pain and Early Functional Outcomes Eric Lloyd Scientific abstract Total Knee
More informationERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland
ERAS: Enhanced Recovery After Surgery Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland Overview History and basic principles of ERAS Review published
More informationBRITISH ASSOCIATION FOR EMERGENCY MEDICINE Registered Charity No
BRITISH ASSOCIATION FOR EMERGENCY MEDICINE Registered Charity No 273876 AT THE ROYAL COLLEGE OF SURGEONS OF ENGLAND 35-43 LINCOLN'S INN FIELDS, LONDON, WC2A 3PE, UNITED KINGDOM Telephone: +44 (0)20 7831
More informationNerve Blocks & Long Acting Analgesia for Plastic Surgeons. Karol A Gutowski, MD, FACS
Nerve Blocks & Long Acting Analgesia for Plastic Surgeons Karol A Gutowski, MD, FACS Disclosures None related to this topic Why is Non-Opioid Analgesia Important Opioid epidemic Less opioid use Less PONV
More informationAnalgesia after c delivery - wound infusions, tap blocks and intrathecal opioids; what more can we offer our patients?
Analgesia after c delivery - wound infusions, tap blocks and intrathecal opioids; what more can we offer our patients? Ashraf S Habib, MBBCh, MSc, MHSc, FRCA Associate Professor of Anesthesiology Interim
More informationImproving Pain Management: The UCSF Journey
Improving Pain Management: The UCSF Journey April 2014 Adam Cooper, RN, MSN Clinical Nurse Educator Institute for Nursing Excellence UCSF Medical Center After this discussion, learners will be able to:
More informationManagement of Acute Pain in the Chronic Pain Patient. Eric Cannon, MD Mountain West Anesthesia December 1, 2017
Management of Acute Pain in the Chronic Pain Patient Eric Cannon, MD Mountain West Anesthesia December 1, 2017 Objectives 1. Describe the unique challenges of managing acute pain episodes in patients being
More informationIs There an Ideal Regimen for CPNB?
Is There an Ideal Regimen for CPNB? Dr Eric Albrecht, MD, DESA Department of Anesthesiology, CHUV 2nd SARA Annual Symposium June 2013 Manuel pratique d ALR échoguidé, Elsevier Masson, Paris, 2013 Albrecht
More informationPAEDIATRIC NERVE BLOCK / WOUND INFILTRATION
PAEDIATRIC NERVE BLOCK / WOUND INFILTRATION Addendum to the MULTIDISCIPLINARY GUIDELINES FOR ACUTE PAIN MANAGEMENT IN CHILDREN AND YOUNG PEOPLE Policy Owner: Approved by: Ratified by: ABMU HB Pain Management
More informationRemifentanil PCA In Labor
Remifentanil PCA In { Jennifer Lucero, MD Clinical Instructor UCSF Department of Anesthesia Remifentanil PCA in Discuss the Pharmokinectics of Remifentanil Review literature on the use of Remifentanil
More informationUCSF PAIN SUMMIT /8/15
UCSF PAIN SUMMIT 2015 5/8/15 Case 3 Geriatric Pain Disclosure Statements UCSF PAIN SUMMIT 2015 Wendy Anderson Patrice Villars 5/8/15 Case 3 Geriatric Pain Pain Management in the Geriatric & End-of-Life
More informationAnalgesia for ERAS programs. Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital
Analgesia for ERAS programs Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital Disclosure I have received honoraria from Mundipharma and MSD The new Wagga Wagga Rural Referral Centre Scope Analgesic
More informationComparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries
Original Research Article Comparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries P V Praveen Kumar 1*, Sreemanth 2 1 Associate Professor,
More informationJames J. Mooney * and Ashley McDonell ** Introduction
Opioid Administration as Predictor of Pediatric Epidural Failure James J. Mooney * and Ashley McDonell ** Background: Increasing use of regional analgesia in pediatric populations requires a better understanding
More informationAnatomy and principles of the fascia iliaca block
Anatomy and principles of the fascia iliaca block Dr Ganesh Kumar 23 rd November 2016 Courtesy Dr Fred Sage Objectives Why do peripheral nerves blocks work? Why choose FIB over FNB? How does it work? How
More informationOriginal Article INTRODUCTION. Abstract
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2018/147 Comparing Two Different Doses of Clonidine as an Adjuvant to Bupivacaine in Blind Fascia Iliaca Compartment Block
More informationRegional Anaesthesia: Minimizing risk and complications. Mafeitzeral Mamat Anaesthesiology & Critical Care Faculty of Medicine UiTM Sg Buloh
Regional Anaesthesia: Minimizing risk and complications Mafeitzeral Mamat Anaesthesiology & Critical Care Faculty of Medicine UiTM Sg Buloh Regional anesthesia is an art. Remembering that even experts
More informationObstacles to appropriate and timely pain relief in the Emergency Department for people with cognitive impairment
Obstacles to appropriate and timely pain relief in the Emergency Department for people with cognitive impairment Lynn Chenoweth Professor, Centre for Healthy Brain Ageing University of New South Wales,
More informationSatisfactory Analgesia Minimal Emesis in Day Surgeries. (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone
Satisfactory Analgesia Minimal Emesis in Day Surgeries (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone HARSHA SHANTHANNA ASSISTANT PROFESSOR ANESTHESIOLOGY MCMASTER UNIVERSITY
More informationPostoperative cognitive dysfunction a neverending story
Postoperative cognitive dysfunction a neverending story Adela Hilda Onuţu, MD, PhD Cluj-Napoca, Romania adela_hilda@yahoo.com No conflict of interest Contents Postoperative cognitive dysfunction (POCD)
More informationAvoiding premedication in children a practical approach
Preoperative preparation and communication in children Avoiding premedication in children a practical approach J. Berghmans M.D. Department of Anesthesia, ZNA Middelheim, Queen Paola Children s Hospital,
More informationMeasure Summary: The opioid equivalency measure examines opioid administration for patients who undergo a surgical procedure.
Measure Abbreviation: Opioid Equivalency Data Collection Method: This informational measure (there is no threshold or target) is calculated based on data extracted from the electronic medical record combined
More informationPostoperative epidural analgesia using local anesthetic
REGIONAL ANESTHESIA SECTION EDITOR DENISE J. WEDEL A Comparison of 0.1% and 0.2% Ropivacaine and Bupivacaine Combined with Morphine for Postoperative Patient-Controlled Epidural Analgesia After Major Abdominal
More informationEffect of Ketorolac on Pain Scores and Length of Stay in Post Anaesthetic Care Unit after Major Abdominal Surgery
Effect of Ketorolac on Pain Scores and Length of Stay in Post Anaesthetic Care Unit after Major Abdominal Surgery Amanat Khan, Ghulam Sabir Iqbal, Azra Naseem, Mohammad Usman Ahmed, Omer Salahuddin Department
More informationOptimal sedation and management of anxiety in patients undergoing endobronchial ultrasound (EBUS)
Optimal sedation and management of anxiety in patients undergoing endobronchial ultrasound (EBUS) Georgios Dadoudis Anesthesiologist ICU DIRECTOR INTERBALKAN MEDICAL CENTER Optimal performance requires:
More informationTurlough O Hare, MD, FRCPC, MSc Assistant Clinical Professor, Department of Anesthesia, St. Joseph s Healthcare Hamilton McMaster University
Turlough O Hare, MD, FRCPC, MSc Assistant Clinical Professor, Department of Anesthesia, St. Joseph s Healthcare Hamilton McMaster University To understand the current options available to best manage pain
More informationAddition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children
British Journal of Anaesthesia 103 (2): 268 74 (2009) doi:10.1093/bja/aep159 Advance Access publication June 18, 2009 Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in
More informationFiegel, Matthew, MD Regional Anesthesia and Pain Medicine Update 2013
Regional Anesthesia and Pain Medicine Update: 2013 CRASH I have no disclosures Disclosures Matthew J. Fiegel, M.D. Associate Professor of Anesthesiology University of Colorado Director, Acute Pain Service
More informationS Kannan, Prem Kumar. Assistant Professor, Saveetha Medical College and Hospital, Chennai.
Original Article CLINICAL COMPARISON OF TWO DIFFERENT VOLUMES OF 0.5% BUPIVACAINE FOR CLAVICULAR SURGERIES USING COMBINED INTERSCALENE AND SUPERFICIAL CERVICAL PLEXUS BLOCK 2 S Kannan, Prem Kumar,2 Assistant
More information9/13/2012. No relevant conflicts of interest to declare
No relevant conflicts of interest to declare Describe appropriate pain assessment in the critically ill patient. Describe special considerations in assessing pain in nonverbal patients. Utilize the hierarchy
More informationCurrent Management of Labour Analgesia Epidural or CSE, Bolus or Infusions?
Current Management of Labour Analgesia Epidural or CSE, Bolus or Infusions? Dr Mark Esler Queen Charlotte s and Chelsea Hospital Imperial College Healthcare NHS Trust 2 nd October 2013 2 kangaroos and
More informationAcute Peri-Operative Pain Management Strategies
Slide 1 Acute Peri-Operative Pain Management Strategies Phillip Gallegos, MD USAP Pinnacle Anesthesiologist Director of Anesthesia and Peri-Operative Medicine BOSHA Slide 2 ERAS Enhanced Recovery After
More information