Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Pain management and postoperative care• Monitor the patient for nausea or vomiting and ensure antiemeticsare administered, if required, as prescribed.• Monitor urinary function – retention is a possibility if the patientis not catheterised.• Monitor for itching and if severe consider the use of naloxone40 µg as prescribed. Inform the anaesthetist or the pain team.• If sudden, severe pain or an increase in pain scores occursinform medical staff so that an examination can be carried out toexclude surgical or medical complications.• Seek immediate anaesthetic advice if cardio-respiratorydepression occurs.• Seek Anaesthetic / Pain Team advice if pain relief is inadequate.Perioperative pain management in patients withchronic pain[Dr Shyam Balasubramanian, December 2007]Anaesthetists commonly come across patients with chronic pain onmultiple medications including high dose opioids; these patients arein a hyperalgesic state making perioperative pain control challenging.Key points• Acute pain management in patients with chronic pain is differentand difficult.• Patients on high dose opioids require perioperative opioidsupplementation to avoid withdrawal syndrome.• Analgesic adjuncts such as antidepressants (amitriptyline) andanticonvulsants (gabapentin, pregabalin) are often overlookedand need to be continued.• Consider regional blocks whenever surgical site permits.Anaesthetists Handbook January 2010 113