Acute Pain Management

  • Alan David Kaye
  • Brooke V. Towne
  • Vibhav B. Reddy
  • Michael F. KelleyJr
  • Si Zhang
  • Lien Tran
  • Elyse M. Cornett
  • Ralf E. Gebhard
Chapter

Abstract

New studies continue to show the increased risk of morbidity and mortality that is associated with poor or ineffective pain control in postoperative settings. The appropriate technical selection must consider several key factors in addition to the patient’s comorbidities and type of surgery being performed. Furthermore, complications related to neural blockade are rare but not completely avoidable. This chapter reviews various agents and techniques that can be used by physicians utilizing a multimodal analgesic model.

Keywords

Postoperative pain Nerve blocks Peripheral nerve block Acute pain Opioid Non-opioid anesthesia 

Notes

Acknowledgment

We wish to thank Dr. Ralf E. Gebhard and Dr. Andres Missair for their significant contributions to the first edition of this chapter.

References

  1. 1.
    Lynch EP, Lazor MA, Gellis JE, Orav J, Goldman L, Marcantonio ER. The impact of postoperative pain on the development of postoperative delirium. Anesth Analg. 1998;86(4):781–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, Cohen SR, Wu CL. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg. 2006;102(1):248–57.CrossRefPubMedGoogle Scholar
  3. 3.
    Hadzic A, Vloka J. Peripheral nerve blocks: principles and practice. New York: McGraw-Hill; 2003.Google Scholar
  4. 4.
    Rosero EB, Joshi FP. Preemptive, preventive, multimodal analgesia: what do they really mean? Plast Reconstr Surg. 2014;134(4 Suppl 2):85S–93S.CrossRefPubMedGoogle Scholar
  5. 5.
    Adriani J. Peripheral nerve blocks: principles and practice. In: Adriani J, Warring H, editors. Blocking of spinal nerves. 4th ed. St. Louis: Warren H. Green; 1985. p. 107–30.Google Scholar
  6. 6.
    Chelly J. Peripheral nerve blocks: a color atlas. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.Google Scholar
  7. 7.
    Borgeat A, Ekatodramis G, Kalberer F, Benz C. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. J Am Soc Anesthesiol. 2001;95(4):875–80.CrossRefGoogle Scholar
  8. 8.
    Corman SL, Skledar SJ. Use of lipid emulsion to reverse local anesthetic-induced toxicity. Ann Pharmacother. 2007;41(11):1873–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology. 2006;105(1):217–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Litz RJ, Popp M, Stehr SN, Koch T. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia. 2006;61(8):800–1.CrossRefPubMedGoogle Scholar
  11. 11.
    Corcoran W, Butterworth J, Weller RS, Beck JC, Gerancher JC, Houle TT, Groban L. Local anesthetic-induced cardiac toxicity: a survey of contemporary practice strategies among academic anesthesiology departments. Anesth Analg. 2006;103(5):1322–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Hilt H, Gramm HJ, Link J. Changes in intracranial pressure associated with extradural anaesthesia. Br J Anaesth. 1986;58(6):676–80.CrossRefPubMedGoogle Scholar
  13. 13.
    Pöpping DM, Elia N, Marret E, Remy C, Tramèr MR. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery. Arch Surg. 2008;143(10):990.CrossRefPubMedGoogle Scholar
  14. 14.
    Friedrich JM, Harrast MA. Lumbar epidural steroid injections. Curr Sports Med Rep. 2010;9(1):43–9.CrossRefPubMedGoogle Scholar
  15. 15.
    de Jong R. Physiology and pharmacology of local anesthesia. 2nd ed. Springfield, IL: Charles C. Thomas; 1970.Google Scholar
  16. 16.
    Axelsson K, Nydahl PA, Philipson L, Larsson P. Motor and sensory blockade after epidural injection of mepivacaine, bupivacaine, and etidocaine—a double-blind study. Anesth Analg. 1989;69(6):739–47.CrossRefPubMedGoogle Scholar
  17. 17.
    Corke BC, Carlson CG, Dettbarn WD. The influence of 2-chloroprocaine on the subsequent analgesic potency of bupivacaine. Anesthesiology. 1984;60(1):25–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Vandermeulen EP, Van Aken H, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg. 1994;79(6):1165–77.CrossRefPubMedGoogle Scholar
  19. 19.
    Wang LP, Hauerberg J, Schmidt JF. Incidence of spinal epidural abscess after epidural analgesia: a national 1-year survey. J Am Soc Anesthesiol. 1999;91(6):1928.CrossRefGoogle Scholar
  20. 20.
    Bonica JJ. Management of pain with regional analgesia. Postgrad Med J. 1984;60(710):897–904. PMCID: PMC2418093. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2418093/.
  21. 21.
    McNicol ED, Ferguson MC, Hudcova J. Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain. In: McNicol ED, editor. Cochrane database of systematic reviews. John Wiley & Sons, Ltd: Chichester, UK; 2015.Google Scholar
  22. 22.
    Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006;332(7553):1302–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Andersohn F, Suissa S, Garbe E. Use of first- and second-generation cyclooxygenase-2-selective nonsteroidal anti-inflammatory drugs and risk of acute myocardial infarction. Circulation. 2006;113(16):1950–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Kirdemi̇r P, Özkoçak I, Demi̇r T, Göḡüş N. Comparison of postoperative analgesic effects of preemptively used epidural ketamine and neostigmine. J Clin Anesth. 2000;12(7):543–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Sichrovsky TC, Mittal S, Steinberg JS. Dexmedetomidine sedation leading to refractory cardiogenic shock. Anesth Analg. 2008;106(6):1784–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Alan David Kaye
    • 1
  • Brooke V. Towne
    • 2
  • Vibhav B. Reddy
    • 3
  • Michael F. KelleyJr
    • 4
  • Si Zhang
    • 5
  • Lien Tran
    • 6
  • Elyse M. Cornett
    • 7
  • Ralf E. Gebhard
    • 8
  1. 1.Department of AnesthesiologyLouisiana State University School of MedicineNew OrleansUSA
  2. 2.School of MedicineLouisiana State University Health Sciences Center—New OrleansNew OrleansUSA
  3. 3.Department of AnesthesiologyTulane UniversityNew OrleansUSA
  4. 4.Department of MedicineLouisiana State University Health Sciences Center—New OrleansNew OrleansUSA
  5. 5.Department of AnesthesiologyTulane University Hospital and ClinicsNew OrleansUSA
  6. 6.Department of AnesthesiologyMontreal General HospitalQCCanada
  7. 7.Department of AnesthesiologyLouisiana State University Health Sciences Center—ShreveportShreveportUSA
  8. 8.Department of AnesthesiologyUniversity of Miami-Miller School of MedicineMiamiUSA

Personalised recommendations