Vol 10, No 2, March/April 2002
PathophysiologicResponses to Poor lyContr olled Pain
Abstract
Pain Management After Major Or thopaedic Sur gery:Curr ent Strategies and New Concepts
Raymond S. Sinatra MD, PhD, Jaime Torres, MD, and Arsenio M. Bustos, MD
Per ipheral Sensitization
Neuroendocr ine Responses
Sympathoadrenal Activation
Pain Management After Major Orthopaedic Surgery
Journal of the Amer ican Academy of Or thopaedic Surgeons
TISSUE INJURY
Atelectasis
Hypoxia
Na+
retention
Venousstasis
Plateletaggregation
Decreasedregional
blood flow
Neuroendocrinealterations
Increased cortisol,hyperglycemia,catabolic state
Immunosuppression,increased risk of
infection
Increasedoxygen
consumption
Sympathoadrenalactivation
Renin-angiotensinrelease
POOR WOUND HEALING
CORONARYISCHEMIA
DEEP VEINTHROMBOSIS
Tachycardia,hypertension
Diminishedpulmonary function
Neural plasticity(dorsal horn)
Neurohumeralalterations
Central processing(cognitive changes)
Facilitatednociceptive
transmission
Peripheralhyperalgesia
Increasedwound sensitivity
ANXIETY
Fear,helplessness
SleepdeprivationMUSCLE
SPLINTING
DEMORALIZATION
IMMOBILIZATION
PNEUMONIA
Chronic Pain
Var iables That InfluenceAcute Pain Management
Techniques of PainManagement
Raymond S. Sinatra, MD, PhD, et al
Vol 10, No 2, March/April 2002
Oral Analgesics
Pain Management After Major Orthopaedic Surgery
Journal of the Amer ican Academy of Or thopaedic Surgeons
PCA Nurse responds
Call for nurse
Screening
Sign outmedication
Preparemedication
Administermedication
PATIENTVARIABLES
NURSINGVARIABLES
UPTAKE/DISTRIBUTION
VARIABLES
Absorptionfrom site
Relief (analgesia)
Sedation
PAIN
Parenteral Therapy
Raymond S. Sinatra, MD, PhD, et al
Vol 10, No 2, March/April 2002
Intravenous Patient-ControlledAnalgesia
Pain Management After Major Orthopaedic Surgery
Journal of the Amer ican Academy of Or thopaedic Surgeons
140
120
100
80
60
400 5 7.5 10 12.5 15 30
Tota
l Mor
phin
e Do
se (m
g)
Ketorolac (mg)
Spinal Opioid Analgesia
Raymond S. Sinatra, MD, PhD, et al
Vol 10, No 2, March/April 2002
Conc
entra
tion
Pain
Seda
tion
Anal
gesia
1 20 3 4 5 6 7 8
Hour
Pain Management After Major Orthopaedic Surgery
Journal of the Amer ican Academy of Or thopaedic Surgeons
Neural Blockade for Acute PainManagement
Raymond S. Sinatra, MD, PhD, et al
Vol 10, No 2, March/April 2002
Other Analgesic Techniques
New Concepts in PainManagement
Pain Services
Pain Management After Major Orthopaedic Surgery
Journal of the Amer ican Academy of Or thopaedic Surgeons
*
60
50
40ControlFemoral nerve blockSciatic-femoral nerve block30
20
10
0Day of Surgery
Day
of S
urge
ry
POD 1 POD 2 POD 3
Preemptive Analgesia
Multimodal Analgesia
Pain Contr ol andPostoperative Outcome
Raymond S. Sinatra, MD, PhD, et al
Vol 10, No 2, March/April 2002
Summary
Pain Management After Major Orthopaedic Surgery
Journal of the Amer ican Academy of Or thopaedic Surgeons
Refer ences
Raymond S. Sinatra, MD, PhD, et al
Vol 10, No 2, March/April 2002