Multimodal Pain Management

Multimodal Pain Management35. W.W., a 36-year-old male, arrives at the ambulatory surgery center for an inguinal hernia repair. This procedure will be performed under local anesthesia, with sedation as needed, and is expected to be completed within 30 minutes. His medical and surgical histories are unremarkable. He is not currently taking any medication and reports no drug allergies. Following discharge from the ambulatory surgery center, how should W.W.'s postoperative pain be managed?In general, one would expect that the greater the magnitude of the surgical trauma, the greater the patient's postoperative pain.145 For minor surgical...

Read More

Epidural Analgesia

Epidural Analgesia29. T.M., a 69-year-old man, enters the surgical ICU after surgery for colorectal cancer (lower anterior resection, urethral stents, ileorectal pull-through). His pain is managed through a lumbar epidural catheter. What are the benefits and risks of epidural analgesia, and why was this approach to postoperative analgesia chosen for T.M.? Advantages and DisadvantagesEpidural analgesia can offer superior pain relief over traditional parenteral (IM and IV PCA) analgesia.158 Continuous epidural infusions offer an advantage over intermittent epidural injections because peak and trough concentrations of drugs are avoided....

Read More

Patient-Controlled Analgesia

Patient-Controlled Analgesia Advantages22. J.A., a 50-year-old, 5′4′′, 50-kg woman, is immediately postoperative from a total abdominal hysterectomy for a neoplasm. Her laboratory values are remarkable for a SrCr of 1.3 mg/dL (normal, 0.6–1.0 mg/dL). She is allergic to penicillin. She will be admitted to the postsurgical floor for a planned stay of 2 to 3 days. What mode of pain management should be chosen for J.A.?PCA is a popular method of administering analgesics and offers several advantages over traditional IM or IV opioid dosing. Patients treated with intermittent IM or IV dosing of opioids “as needed” can experience severe pain...

Read More

Antiemetic Agents and Postoperative Nausea and Vomiting

Antiemetic Agents and Postoperative Nausea and Vomiting Impact of Postoperative Nausea and VomitingPONV is a relatively common (overall incidence, 25%-30%) yet highly undesirable anesthetic and surgical outcome. Patients who develop PONV are greatly dissatisfied with their surgical experience and require additional resources such as nursing time and medical/surgical supplies. PONV typically lasts <24 hours; however, symptom distress can...

Read More

Cardioplegia Solution

Cardioplegia Solution Use in Cardiac SurgeryHypothermic, hyperkalemic cardioplegia solution was first used in open heart surgery in the 1970s and enjoys widespread clinical use today. Cardioplegia solution is infused into the coronary vasculature to produce an elective diastolic cardiac arrest. Inducing cardiac arrest, or cardioplegia, helps protect the myocardium while providing the surgeon with a still, bloodless operative field and a flaccid heart on which to work. Cardioplegia solution is administered via the cardiopulmonary bypass pump (a heart-lung machine) through specialized circuits. During open heart surgery, the heart is excluded...

Read More