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Category: Pain

Posted in: ATOTW > Pain 2020 Language: english

This tutorial covers basic physiology and the principles of pain management including assessment, pharmacologic and regional analgesia techniques in elderly patients.

Posted in: ATOTW > Pain 2020 Language: english

Opioids are a cornerstone of anaesthetic practice. This tutorial will discuss a common opioid side effect - Opioid-induced Hyperalgesia (OIH). OIH is a phenomenon for which we have an increasing appreciation. We will discuss its proposed mechanism, clinical relevance and, lastly, evidence on its management strategies.

Posted in: UIA > Pain 2020 Language: english

After decades of turmoil Timor-Leste is re-building its healthcare system. Resource limitations are severe. Opiates are unavailable on the wards and used sparingly in theatres. Minimal staff training, inadequate medication supply and cultural acceptance result in poor pain management. This audit examines post-operative pain management in 85 patients thought reasonably to require post-operative analgesia. Despite medication being charted 20 patients (24%) received no post-operative analgesia, (before review). This group had a mean verbal numeric pain score of 5.8+/-2.2, median 6, range 2-9. Thirty-four patients (41%) received some of their charted analgesics. This group had a mean pain score of 5.1+/-2.2, median 5, range 1-9. The remaining 31 patients received their analgesics as charted and, unsurprisingly, had the lowest pain scores, mean 4.3+/-2.3, median 4, range 1-8. No patient received prn analgesia. More than 40% of patients reported pain scores greater than 5, with 15% reporting pain scores of 8 or 9. Forty-seven patients (55%) were unsatisfied with their pain relief. Fifty-one patients (60%) received additional analgesia as a result of review. Despite cultural expectations Timorese patients would welcome additional post-operative analgesia. To achieve this there are significant hurdles to overcome in training, drug availability and attitudes towards pain relief.

Posted in: ATOTW > Pain 2019 Language: portuguese

O tramadol e o tapentadol são duas moléculas sendo usadas para tratar dor aguda. Neste tutorial, discutimos a farmacologia básica, segurança e eficácia de ambos os medicamentos. Além disso, são discutidas as indicações para uso, recomendações de segurança, e potencial de consumo abusivo.

Posted in: ATOTW > Pain 2019 Language: english

Tramadol and tapentadol are two related molecules that are being used to treat acute pain. In this tutorial we discuss the basic pharmacology, safety and efficacy of both medications. As well, indications for use, safety recommendations and abuse potential are discussed.

Posted in: Other Publications (Books & Journals) > Pain 2018 Language: english

Cesarean delivery is one of the most common surgical procedures in the United States, with over 1.3 million performed annually. One-fifth of women who undergo cesarean delivery will experience severe pain in the acute postoperative period, increasing their risk of developing chronic pain and postpartum depression, and negatively impacting breastfeeding and newborn care. A growing body of research has investigated tools to predict which patients will experience more severe pain and have increased analgesic consumption after cesarean delivery. These include quantitative sensory testing, assessment of wound hyperalgesia, response to local anesthetic infiltration, and preoperative psychometric evaluations such as validated psychological questionnaires and simple screening tools.

Posted in: ATOTW > Regional Anaesthesia & Pain 2018 Language: english

This tutorial covers ultrasound-guided paravertebral nerve block. It discusses the basic anatomy, indications and complications associated with this peripheral regional anaesthesia. The article goes into detail the preparation required to carry out this block and discusses 3 common ultrasound-guided approaches that can be utilized.

Posted in: Guidelines & Standards > Pain 2018 Language: english

Possible reasons for the inadequate postoperative pain management include limited financial resources, lack of time and personnel, but also reluctance to address this issue, organizational aspects of the health care facility, and lack of simple and clear guidelines for the treatment of postoperative pain. Providing such easy-to-follow recommendations is one of the objectives of this book. The availability of postoperative analgesia to anyone who needs it requires a high-quality postoperative pain management, as well as accepting and understanding the fact that good analgesia is not only necessary, but also a fundamental right of every patient suffering from pain and a basic duty of any health care facility that treats these patients.

Posted in: ATOTW > Pain 2018 Language: spanish

La Buprenorfina/Naloxona (Suboxone®, Zubsolv®, Bunavail®) es una terapia basada en la evidencia cada vez más popular para el trastorno por consumo de opioides. Este tutorial describe su farmacología, los desafíos que plantea para el manejo anestésico y las estrategias para proporcionar analgesia perioperatoria a pacientes con buprenorfina/naloxona.

Posted in: ATOTW > Pain 2018 Language: chinese

丁丙诺啡-纳洛酮合剂 (例如Suboxone®(丁丙诺啡-纳洛酮), Zubsolv®(丁丙诺啡-纳洛酮舌下速溶片), Bunavail®(丁丙诺啡-纳洛酮颊膜片)) 经循证医学支持,是目前越来越受欢迎的一种用于治疗阿片类药物应用障碍的药物。此指南旨在介绍其独特的药理学特性,主要用于指导患者的麻醉及围术期疼痛管理。

Posted in: ATOTW > Pain 2018 Language: portuguese

A buprenorfina / naloxona (i.e, Suboxone®, Zubsolv®, Bunavail®) é uma terapia cada vez mais popular baseada em evidências para o transtorno de uso de opiáceos. Este tutorial descreve sua farmacologia única, os desafios que representa para o manejo anestésico e as estratégias para fornecer analgesia perioperatória a pacientes com buprenorfina / naloxona.

Posted in: ATOTW > Pain 2018 Language: english

Buprenorphine/naloxone (i.e. Suboxone®, Zubsolv®, Bunavail®) is an increasingly popular evidence-based therapy for opioid use disorder. This tutorial describes its unique pharmacology, the challenges it poses to anesthetic management and the strategies for providing perioperative analgesia to patients on buprenorphine/naloxone.

Posted in: Video > Pain 2017 Language: english

Set in Papua New Guinea, the film explores the nature of pain management at hospitals on the island and the beginnings of the Essential Pain Management (EPM) course. Learn more:

Posted in: Video > Pain 2017 Language: english

The film explores the nature of pain management at hospitals in Argentina, the Essential Pain Management (EPM) course and the impact it will have on patients. Learn more:

Posted in: Video > Pain 2017 Language: english

The film explores the nature of pain management at hospitals in Argentina, the Essential Pain Management (EPM) course and the impact it will have on patients [in Spanish]. Learn more:

Posted in: Video > Pain 2017 Language: english

Alu, a trainee anaesthetist in Papua New Guinea, talks about his interest in pursuing a career treating pain as an anesthetist and about the Essential Pain Management (EPM) course. Learn more:

Posted in: ATOTW > Pain & General Topics 2017 Language: chinese


Posted in: UIA > Pain & Basic Sciences 2017 Language: english

Knowledge of the pharmacological differences between opioids can be applied to select the appropriate drug for the relevant clinical setting and minimise the impact of side-effects. Over the last 20 years more information regarding the pharmacodynamics and pharmacokinetics in terms of opioid receptor dimers and oligomers, second messenger system effects and genotyping has come to light. Originally published as Anaesthesia Tutorial of the Week #277, 3 December 2012

Posted in: ATOTW > Pain & General Topics 2017 Language: portuguese

Opióides intratecais promovem analgesia efetiva para uma variedade de procedimentos cirúrgicos. Este tutorial apresenta uma visão geral das indicações clínicas, complicações e recomendações sobre sua segurança e uso efetivo.

Posted in: ATOTW > Pain 2017 Language: spanish

Los opioides intratecal proporcionan analgesia eficaz para una variedad de procedimientos quirúrgicos. Este tutorial proporciona una visión general de las indicaciones clínicas, complicaciones y recomendaciones sobre su uso seguro y eficaz.

Posted in: ATOTW > Pain & General Topics 2017 Language: english

Intrathecal opioids provide effective analgesia for a variety of surgical procedures. This tutorial provides an overview of the clinical indications, complications and recommendations on their safe and effective use.

Posted in: Other Publications (Books & Journals) > Pain 2016 Language: english

More than 2 billion of the world’s population reside in low- and middle-income countries. In these countries, provision of emergency, essential surgical care, and anesthesia that have been shown to decrease mortality and disability is limited.1,2 One of the reasons could be that providing anesthesia in these countries can be challenging because of inadequate infrastructure and equipment. In addition, these countries have a shortage of trained anesthesiologists, and thus, nonphysician anesthesia providers generally provide anesthesia services in the rural and underserved hospitals.3–5 In such circumstances, it is necessary to use anesthetic drugs and techniques with safe profiles.

Posted in: Other > Pain 2016 Language: english

Welcome to the second edition of the South African Acute Pain Guidelines. It has been revised, incorporating new drugs and recent advances in acute pain management. These guidelines are recommended for use by all medical practitioners involved in acute pain management of adults and children. Guidelines should always be viewed as “works in progress”, and the Regulation Business Unit of the South African Society of Anaesthesiologists would appreciate inputs from colleagues from all sectors of medical practice over the next few years.

Posted in: Other > Pain 2015 Language: english

This fourth edition sums up the evidence currently available to assist health professionals in the management of acute pain. Schug SA, Palmer GM, Scott DA, Halliwell R, Trinca J; APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine (2015), Acute Pain Management: Scientific Evidence (4th edition), ANZCA & FPM, Melbourne.

Dor é uma causa comum de apresentação ao hospital em pacientes pediátricos. A dor pode ter impacto direto em desfechos em saúde e, caso não seja controlada, pode exercer efeitos diversos em todas as áreas da vida. Isso ocorre porque a dor é não somente uma percepção sensorial, mas envolve também componentes emocionais, cognitivos e comportamentais que devem ser reconhecidos. O impacto e a percepção da dor são também influenciados pela bagagem sociocultural, ambiental e de desenvolvimento individual de cada paciente. Há evidências de que a dor, caso não seja tratada adequadamente, pode exercer efeitos deletérios a longo prazo sobre a sensibilidade dolorosa, o funcionamento do sistema imunológico, a neurofisiologia e o comportamento quando a cuidados em Página 2 of 9 saúde. Portanto, é essencial que profissionais da saúde envolvidos no cuidado de crianças de todas as idades sejam treinados para reconhecer e tratar a dor, seja ela aguda ou crônica.

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