Aidan: /* Moderate-to-Severe Pain */

2021-11-02T12:54:55Z

Moderate-to-Severe Pain

← Older revision		Revision as of 12:54, 2 November 2021
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	* Consider patient-controlled anaesthesia (PCA)		* Consider patient-controlled anaesthesia (PCA)
	* Consider postoperative regional anaesthetic		* Consider postoperative regional anaesthetic
	* Consider [[ketamine]] ~~infusion~~		* Consider intravenous [[ketamine]]
			**Intermittent infusion: 0.1 mg/kg IV q4h, titrated to maximum dose of 0.35 mg/kg
			**Continuous infusion: 0.1 mg/kg/h IV continuous infusion, titrated to maximum dose 0.25 mg/kg/h
	* Consider [[lidocaine]] infusion		* Consider [[lidocaine]] infusion
	* Consider [[cannabinoids]]		* Consider [[cannabinoids]]

Aidan: Created page with "== Background == * Acute pain is common after surgery, and for many it will be moderate or severe * Postoperative pain is associated with poor clinical outcomes, patient diss..."

2021-05-07T15:46:51Z

Created page with "== Background == * Acute pain is common after surgery, and for many it will be moderate or severe * Postoperative pain is associated with poor clinical outcomes, patient diss..."

New page

== Background ==

* Acute pain is common after surgery, and for many it will be moderate or severe
* Postoperative pain is associated with poor clinical outcomes, patient dissatisfaction, and long-term morbidity including chronic pain
* Normal healing can take up to 3 months; pain lasting beyond this time is assumed to be pathologic

== Clinical Manifestations ==

* Typical postoperative pain is nociceptive, well-localized, described as sharp, aching, or throbbing

=== Prognosis and Complications ===

* Results in decreases in quality of life, sleep, physical activities, and mental status
* May result in chronic pain

== Management ==

=== Preoperative ===

* Evaluation and assessment for risk of severe postoperative pain
* Consider referral to Acute Pain Service

=== Intraoperative ===

* Regional or neuraxial anaesthetic is preferred for those at high risk of postoperative pain
* Intraoperative lidocaine or ketamine infusions can be considered

=== Postoperative ===

* Comprehensive daily pain assessment

==== Mild Pain ====

* First-line: [[acetaminophen]] 500 to 1000 mg PO q6h for 3 to 5 days, plus one of:
** [[Celecoxib]] 100 to 200 PO bid for 3 to 5 days, or
** [[Ibuprofen]] 200 to 800 mg PO bid for 3 to 5 days, or
** [[Naproxen]] 250 to 500 mg PO bid for 3 to 5 days
* If NPO: [[acetaminophen]] 1000 mg IV q6h (if available) for 3 to 5 days plus [[ketorolac]] 15 mg IV q8h for 3 days
* As well as one of the following:
** [[Oxycodone]] 5 to 10 mg PO q4h prn
** [[Hydromorphone]] 1 to 2 mg PO q4h prn
** [[Morphine]] 5 to 15 mg PO q4h prn

==== Moderate-to-Severe Pain ====

* Standing [[acetaminophen]] and [[NSAIDs]], if possible
* Consider patient-controlled anaesthesia (PCA)
* Consider postoperative regional anaesthetic
* Consider [[ketamine]] infusion
* Consider [[lidocaine]] infusion
* Consider [[cannabinoids]]
* Consider [[gabapentinoids]]

[[Category:Perioperative medicine]]
[[Category:Anaesthesia]]

Postoperative pain - Revision history

Aidan: /* Moderate-to-Severe Pain */

Aidan: Created page with "== Background == * Acute pain is common after surgery, and for many it will be moderate or severe * Postoperative pain is associated with poor clinical outcomes, patient diss..."