Lisa Johnson, Ba, SRS, Latg Certification Review Session 2010 Asr Annual Meeting Clearwater Beach, FL
Lisa Johnson, Ba, SRS, Latg Certification Review Session 2010 Asr Annual Meeting Clearwater Beach, FL
Lisa Johnson, Ba, SRS, Latg Certification Review Session 2010 Asr Annual Meeting Clearwater Beach, FL
• Accepted definition:
– An unpleasant sensory (noxious) and
emotional experience associated with actual
or potential tissue damage
– Anything which would cause more than
momentary pain in humans, should be
assumed to cause pain in an animal
Definitions
• Stimulation of • Various
medulary centers neurotransmitters are
result in released: glutamate,
hyperventilation, norepinephrine,
increased cardiac serotonin, gamma-
aminobutyric acid
output, and increased
(GABA) and endorphins
blood pressure
• Analgesia can be
• Descending neurons induced by blocking the
act to modulate pain nociceptive process at
by reducing sensation one or more points
Physiology of Pain
Pain ≠ Nociception
What is the difference?
Pain is a product of higher brain center processing of
signals it has received.
Nociception refers to the peripheral and central nervous
systems processing information generated by stimulation
of nociceptors by noxious stimuli
Nociception can occur in the absence of pain.
Physiology of Pain
Transduction:
– Can be blocked by local anesthetics by injection either at the site
of injury/incision or intravenously
– Can be decreased by use of NSAIDs which decrease the
production of prostaglandins at the site of injury
Transmission:
– Can be prevented by local anesthetics by injection along
peripheral nerves, at nerve plexus, or in the epidural or
subarachnoid spaces
Modulation:
– Can be augmented by injection of local anesthetics or alpha2-
adrenergic agonists; gabapentin may also effect modulation
Perception:
– Altered by use of general anesthetics or systemic injection of
opioids and/or alpha2-agonists
Actions of Analgesics on Pain
Processes
• “Splash”
– Can apply to exposed tissues prior to closure and
nerves prior to transection during amputations
– “Soaker catheters”
• Infiltration
– Multiple intradermal or subcutaneous injections of
local anesthetic along proposed incision line
– May contain epinephrine (1:200,000) to increase
effect and duration
• Field block
– Used to anesthetize large areas
• Intradermal or SQ infiltration followed by injection
deeply enough to infiltrate nerves
Local Anesthetics
• Epidurals
– Administered alone or in combination with
other analgesics
– If combined, smaller doses can be used,
decreasing risks of adverse effects
– Can cause motor deficits at higher doses
Alpha2-Adrenergic Agonists
• Tramadol
– Synthetic opioid agonist which also inhibits serotonin and
norepiniphrine re-uptake in the spinal cord
– The main metabolite has moderate opioid activity
• Ketamine
– NMDA antagonist
– Used as a CRI during surgery at sub-anesthetic doses, it
reduces MAC and can help prevent hypersensitivity
– More effective treating somatic pain than visceral pain
– Can be administered via epidural injection
• Gabapentin
– Analogue of naturally occurring neurotransmitter GABA
– Believed to increase production of GABA
• Part of endogenous inhibition of nociception
– Used to treat nerve pain
Pain Assessment
• Definitions
• Types of pain
• Pain pathway
• Types of analgesics and their action
• Pain assessment
References