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60 Cards in this Set
- Front
- Back
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What are 5 reasons we use pain management in vet med?
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Procedures are perceived to be painful in animals, owners concerns, new gen anesthetics are much better, decreased movement due to pain no longer seen as protective, survival rate & recovery time improve w/ pain management.
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What the goal of pain management?
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Allow patient to move, eat & sleep w/out undue discomfort; focused on first 12-24 hrs after routine surgery; longer if sever traums occured or espcially painful surgery.
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What are nociceptors?
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Sensory nerve cells in skin or deep tissue that can detect a noxious stimulus & convert it to nerve impulses.
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How are impulses transmitted by neurons?
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It's a chain of at least 3 neurons. Sensory neuron in tissue-spinal cord neuron-brain neuron (where pain in perceived).
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What are 2 types of sensory neurons?
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A delta fibers & C fibers.
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What are A delta fibers?
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Sensory neurons; myelinated nerve axons.
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What are C fibers?
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Sensory neurons; nonmyelinated nerve axons.
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Characteristics of A delta fibers?
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Sharp, discret pain; fast transmission; patient can localize the site easily.
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Characteristics of C fibers.
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Dull, aching or throbbing pain; slow transmission; patient cannot easily pinpoint the source.
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What are the 2 types of pain?
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Somatic & visceral.
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What is somatic pain?
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Pain in the skin, SC, muscle, bone & joints. Both A delta and C fibers are involved.
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What is visceral pain?
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Pain in the internal organs. Primarily C fibers only.
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How do you classify intensity of pain?
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Mild, moderate & severe.
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How do you classify the duration of pain?
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Acute or chronic.
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Which is more response the analgesics: acute or chronic?
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Acute.
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What is referred pain?
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It's felt in a body part other than the cause.
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What is hyperesthesia?
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An increased sensitivity to stimulus.
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What is neuropathic pain?
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It's due direct damage to peripheral nerves or spinal cord; often poorly responsive to analgesics.
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What are two factors which will affect the type of pain produced?
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The type of tissue and the amount of damage to the tissue.
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How does the type of tissue affect the pain produced?
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Tissue with large numbers of nerve ending or nerve themselves have more pain.
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What types of tissues will have more pain?
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Ears, eyes, bones, joints, nerves, cervical discs; thoracic surgery is more painful than abdominal.
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How does the amount of damage to the tissues affect the type of pain produced?
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Large amounts of tissue damaged or removed will be more painful.
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Which types of tissue damage will have more pain?
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Mastectomy, enucleation, burns, hip replacement.
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What are some signs of pain?
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Decreased activity; restlessness; limping; increased HR, RR; abnormal body posture, dilation of pupils, depression, inappetance, vocalization, trembling/shaking, inability to sleep, licking or chewing.
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How do you anticipate the amount of pain an animal is in so you can treat it?
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The more signs, the more pain they're in. Treat to the expected level of pain for a their particular procedure or trauma.
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What is preemptive use?
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Administering drugs before or during surgery.
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What are 3 ways to use drugs preemptively?
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Analgesics used as preanesthetics, epidurals & local or regional nerve blocks
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What is windup?
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A buildup of chemical mediators in spinal cord that intensify the perception of pain.
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What helps to prevent windup?
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Preemptive drugs.
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How do preemptive drugs prevent windup?
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Surgical manipulation leads to mediators being released & remain in spinal cord leads to intensifying pain perception upon recovery.
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What's a benefit for using a preemptive drug?
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You don't need as much general anesthetic. You can use an analgesic drug during surgery rather than increasing anesthetic depth if patient shows signs of pain.
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What are 4 types of drugs used for preemptive use?
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NSAIDS, local anesthetics, opioids & balanced or multimodal analgesia.
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How do NSAIDs work as a preemptive drug?
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They work at tissue level. Prevent prostaglandin production by inativating enzymes involved.
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Do NSAIDs have a direct affect on the brain?
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Some of them do.
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How do local anesthetics work as a preemtive drug?
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They block transmission of pain impulses in sensory nerves.
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How do opioids work as a preemptive drug?
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They affect sites in brain & spinal cord to decrease perception of pain.
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What is balanced or multimodal analgesia?
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Using drugs from more than one class of analgesic.
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Builup of chemical mediators in spinal cord that intensify the perception of pain is what?
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Windup.
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How do balanced or multimodal analgesic drugs work as a preemptive drug?
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The can decrease the amount of each drug - decreases side effect. It's a more effective pain relief.
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What 3 things are opioids used for?
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Preanesthetics, neuroleptanalgesia & post operative pain control.
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How do opioids work as a preanesthetic?
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They have a short duration (2-4 hrs). They are not as affective as local anesthetics to prevent windup.
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When you use a pure agonist opioid for moderate to severe pain what are the affects?
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Significant sedation, excellent analgesia; significant respiratory & cardiovascular side effects.
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What are some pure agonist opioid used for moderate to severe pain?
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Morphine, hydromorphone, oxymorphone, fentanyl.
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What agonists would you use for mild to moderate pain?
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Weak agonists - meperidine, buprenorphine, nalbuphine.
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Which opioid is both an agonist and antagonist?
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Butorphanol.
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Are NSAIDs an effective analgesic for somatic or visceral pain?
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Somatic (skin/muscle).
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How long does it take for NSAIDs to take effect?
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30-60 mns.
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When are NSAIDs most often used? Preanesthetic, maintenance, induction, postoperative?
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Postoperatively.
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What are 3 significant side effects of NSAIDs that may increase a patients surgical risk?
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Decreased platelet aggregation & renal blood flow. It's metabolized by the liver & excreted by kidney or bile.
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What are some precautions to take when using NSAIDs?
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Try not to use preemptively - if needed give IV fluids; use only in young to middle-aged healthy dogs; use carprofen; screen presurgically for kidney & liver function.
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Which NSAIDs can you use to reduce the ulcerogenicity effects?
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Carprofen, etodolac & meloxicam.
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What else can you do to reduce the ulcerogenicity of NSAIDs besides using carprofen, etodolac or meloxicam?
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Give with a meal & use GI protectants (sucralfate).
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What are 4 advantages of NSAIDs over opioids?
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Can be given oral; not controlled; little effect on respiratory or cardiovascular function; no sedative effect (for postop use).
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What are some contraindications for using NSAIDs?
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Tylenol toxic to cats; dehydrated or hypotensive patients; liver or kidney dysfunction; corticosteroids; GI disorders; low blood pressure; congestive heart failure; clotting disorders.
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General characteristics of local anesthetics.
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Preemptive use only; short duration; potential for toxicity.
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General characteristics of alpha2 agonists.
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Short duration; profound sedative effect; serious side effects; use only in young to middle-aged healthy animals; epidural, alone or with opiois is an option.
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What are some serious side effects of alpha2 agonists?
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Respiratory depression, vomiting, bradycardia, heart block, hypotension.
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General characteristics of ketamine.
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Preanesthetic in cats (IM,SC); IV, IM or PO for pain if other drugs not available - useful in trauma at low dose - little resp/cardiovascular effect.
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When is ketamine contraindicated?
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Cardiac or renal disease.
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General characteristics of tranquilizers.
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No direct analagesic effect; calm patients, allow opioids to work; use for opioid-induced excitement.
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