Perianesthesia nurses have an active and pivotal role in the management of pain. They teach patients about the pain experience before surgery and are the first defense in preventing and fighting pain after surgery. They are the patient’s advocate when adjustments in the treatment plan must be made to optimize pain relief. This chapter discusses the types of pain seen in the perioperative setting and the analgesics used to treat patients. Practical tips on the management of patients who are opioid tolerant, those with chronic (persistent) pain, and patients with addictive disease are provided. The importance of providing both effective and safe pain relief is emphasized throughout the chapter.
1.What is the definition of pain?
2.What is the difference between acute pain and chronic (persistent) pain?
3.What is the difference between nociceptive pain and neuropathic pain?
4.What is the best way to assess pain in patients who can report pain in the postanesthesia care unit?
5.What is the best way to assess pain in patients who cannot report pain in the PACU?
6.Is it acceptable to assume that pain is present in patients who cannot report pain after surgery?
7.Are behaviors reliable indicators of pain?
8.Is a behavioral pain score the same as a pain intensity rating?
9.Are physiologic parameters, such as blood pressure and pulse, reliable indicators of pain?
10.Should patients be asked to establish a pain rating goal preoperatively?
11.Should the criteria for discharge from the PACU include the requirement that patients must achieve their pain rating goal?
12.What is the recommended approach for the management of pain in the immediate postoperative period?
13.What is the difference between multimodal analgesia and polypharmacy, and how can the risks associated with polypharmacy be minimized?
14.What is preemptive analgesia and does it work?
15.What are the primary pharmacologic strategies for the management of postoperative pain?
16.Which first-line opioid is best to treat immediate postoperative pain, and is there value in using more than one for this type of pain?
17.What is the correct way to titrate IV opioid analgesics?
18.Is there a predictable relationship between pain intensity and opioid dose requirement?
19.Why are anticonvulsants used to treat postoperative pain?
20.Is the rectal route an acceptable route for analgesic administration in the perioperative setting?
21.What are the patient selection criteria for using patient-controlled analgesia?
22.Should IV PCA therapy be initiated in the PACU?
23.What methods are used to administer intraspinal (epidural, intrathecal) analgesia?
24.What is extended-release epidural morphine?
25.What is a continuous peripheral nerve block?
26.What is a continuous local anesthetic wound infusion?
27.How should the effectiveness of the pain treatment plan be evaluated?
28.What should be done if the pain treatment plan is not effective?
29.What is the relationship between anxiety and pain, and how are they differentiated and treated?
30.What is the difference between an opioid-tolerant patient and one who is opioid-naïve?
31.What is the difference between opioid addiction, physical dependence, and tolerance?
33.What is the risk of opioid addiction when opioids are taken for pain relief?
34.What can be done to improve pain management in the postoperative patient with underlying persistent (chronic) pain?
35.What can be done to improve the pain experience for the opioid-tolerant patient undergoing surgery?
36.How should postoperative pain be treated in a patient with addictive disease?
37.What are the most common adverse effects of NSAIDs in the perioperative setting and what approaches are used to minimize and manage them?
38.What are the adverse effects of local anesthetics?
39.What are the most common adverse effects of opioid analgesics in the perioperative setting and what approaches are used to minimize and manage them?
40.Are there any long-term adverse effects of opioid analgesics?
41.How should sedation be assessed during opioid administration?
42.Does a patient’s level of sedation correspond with pain relief?
43.How can clinically significant opioid-induced respiratory depression be prevented?
44.What is the correct technique for administering naloxone to reverse opioid-induced respiratory depression?
45.What information about pain control should be included in handoff communication?
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