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benefit of intravenous, patient controlled (IV PCA) versus intravenous, intramuscular, and transdermal iontophoretic pain medication administration Advantages and Disadvantages of Modes of Drug Administration IV PCA Intermittent IV Intramuscular Transdermal Iontophoretic System Access for the patient: Readily available when needed Needs trained personnel Needs trained personnel Easy, noninvasive Bioavailability: Good Good Depends on tissue perfusion …

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options using nonsteroidal antiinflammatory drugs in the perioperative period Perioperative administration of COX-2 inhibitors for total joint arthroplasty has been shown to result in a reduction in perioperative pain and improvement in outcomes without the added risk of increased perioperative bleeding. Currently available nonsteroidal antiinflammatory drugs (NSAIDs) for parenteral administration in United States are ketorolac …

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What is preventive analgesia? The focus of preventive analgesia is not on the relative timing (preemptive analgesia) of analgesic interventions, but on attenuating the impact of the peripheral nociceptive barrage associated with noxious preoperative, intraoperative, and/or postoperative stimuli. By interrupting the transmission of the peripheral nociceptive barrage to the spinal cord throughout the perioperative period, …

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What are the predictors of postoperative pain? Preoperative pain, anxiety, young age, obesity, surgical fear, catastrophizing, and type of surgery (abdominal, orthopedic, and thoracic surgery, long duration), age, and psychological distress have been identified as predictors of postoperative pain. Intensity of perioperative pain, old age, obesity, depression, psychological vulnerability, stress, and duration of disability (time …

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phenomenon of peripheral and central sensitization Sensitization of peripheral nociceptors may occur upon noxious stimuli and is marked by a decreased threshold for activation. This may lead to functional changes in the dorsal horn of the spinal cord that may later cause postoperative pain to be perceived as more painful than it would otherwise have …

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Pathophysiology of postoperative pain Surgery produces tissue injury with consequent release of histamine and inflammatory mediators, such as bradykinin, substance P, prostaglandins, neurotransmitters (e.g., serotonin), and neurotrophins (e.g., nerve growth factor). Noxious stimuli are transduced by peripheral nociceptors and transmitted by A-delta and C nerve fibers from peripheral visceral and somatic sites to the dorsal …

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Joint Commission Standards for Pain Management The Joint Commission on Accreditation of Hospitals recommends the following six standards: • Recognize the right of individuals to appropriate pain management. • If pain exists, determine this and also assess the nature and intensity. • Establish policies and procedures to support ordering safe, effective pain medication. • Educate patients and families about …

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