Anaesthetists Handbook - MEDICAL EDUCATION at University ...

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Gabapentin in acute painGabapentin in acute pain[Dr Shyam Balasubramanian, January 2010]Gabapentin has an established role in chronic pain management.There is growing evidence for its use in acute pain as well. Althoughthe precise molecular mechanism is unclear, it could be explained byprevention or reduction of the development of central neuronalhyperexcitability induced by the surgical procedure.Clinical informationIndications1. Resistant postoperative pain unresponsive to conventionalmanagement.2. Background history of chronic pain (e.g. fibromyalgia)experiencing exaggerated perception of acute pain.3. Sensitivity to opioids (anaphylaxis, severe PONV etc.).4. Procedures which can predispose to neuropathic pain (e.g.amputation, ‘abnormal’ pain behaviour following hernia, breastsurgery etc.).5. Post-dural puncture headache.Advantages1. Opioid-sparing effect.2. Reduced PONV.3. Reduction in pain associated with movements.4. Anxiolysis5. Prevention of chronic postsurgical pain syndromes.174 Anaesthetists Handbook January 2010
Gabapentin in acute painSide-effectsMild to moderate somnolence.CautionIn patients with significant renal or hepatic impairment.Recommended doseGabapentin is presented as capsules of 100 mg, 300 mg and400 mg; also tablets of 600 mg and 800 mg.A single dose of oral gabapentin 600 mg to 1200 mg one or twohours before surgery has been shown to significantly reducepostoperative opioid consumption.A useful regime from the University of Western Ontario, Canada isoral gabapentin 300 mg three times a day, preferably to be startedpreoperatively. The duration of treatment can be three to seven daysdepending on the surgery and intensity of pain.There is no need for gradual weaning of GBP when used to treatacute pain.ConclusionPerioperative gabapentin is a useful adjunct for the management ofacute pain. It provides analgesia through a different mechanism thanopioids and other analgesics. It is generally well tolerated withminimal drug interactions.Further reading• Dierking. Effects of gabapentin on postoperative morphineconsumption and pain after abdominal hysterectomy: Arandomized, double-blind trial. Acta AnaesthesiologicaScandinavica 2004; 48(3): 322-7• Dogan Erol. The effect of oral gabapentin on postdural punctureheadache. Acute Pain 2006; 8(4): 169-73Anaesthetists Handbook January 2010 175
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Department of AnaesthesiaAnaestheti
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Document control for approved clini
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ContentsTrauma list anaesthetist (t
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ContentsStudy leave 81Junior doctor
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ContentsIndications for investigati
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ContentsRenal patients - clinical g
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Introduction and scope of guideline
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Introduction and scope of guideline
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Airway assessmentManaging difficult
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Managing difficult airways• Flexi
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Managing difficult airways• Manuj
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Resuscitation - advanced life suppo
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Resuscitation - advanced life suppo
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Duties of the on call anaesthetists
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Getting senior helpGetting senior h
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On call casesGetting senior helpYou
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Supervision for sick patientsGettin
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Calling the senior resident anaesth
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Perianaesthesia Care Unit (PACU)PAC
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PACUThe surgical team responsible f
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PACU6. Oxygen and intravenous thera
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Integration with the critical care
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Inter-hospital transfersInter-hospi
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Inter-hospital transfersConsultant
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Signing onAdministrative issuesYour
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Administrative issuesMobile phones
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Administrative issuesobstetrics, we
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Administrative issuesMain theatre r
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CLWrota processes• To complete ca
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Security rules:• Do not put confi
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Education and trainingthe Royal Col
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Education and trainingthe necessary
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Education and trainingarrive in the
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Education and traininginformation c
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Education and trainingexamination i
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Education and trainingAll consultan
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Presenting at seminars• Bring har
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Presenting at seminarsDOI advise yo
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Clinical adverse event reportingCli
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Clinical auditClinical audit[Apprai
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Clinical auditYour presentation sho
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Pain management and postoperative c
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Signs and symptomsAgitation, anxiet
Page 123 and 124: Epidural anaesthesia and analgesiaP
Page 125 and 126: Epidural anaesthesia and analgesiai
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Page 129 and 130: IndicationsEpidural anaesthesia and
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Page 133 and 134: Assessment and treatment optionsEpi
Page 135 and 136: Epidural anaesthesia and analgesia3
Page 137 and 138: Epidural anaesthesia and analgesia
Page 139 and 140: Epidural anaesthesia and analgesiaA
Page 141 and 142: Epidural anaesthesia and analgesiaG
Page 143 and 144: Allergies and adverse drug reaction
Page 149 and 150: Awareness during anaesthesiaPrevent
Page 151 and 152: Fractured neck of femur:management
Page 153 and 154: Fractured neck of femurGuidelines f
Page 155 and 156: Management of patients with diabete
Page 157 and 158: Patients who take insulinManagement
Page 163 and 164: Preoperative assessment and investi
Page 167 and 168: Indications for investigationsFull
Page 171 and 172: SevofluraneSevoflurane[Dr Mark Port
Page 173: Sevofluranemust be considered on it
Page 177 and 178: Blood and blood productsBlood and b
Page 179 and 180: Blood and blood productsWhen the un
Page 181 and 182: Blood and blood productsCross match
Page 183 and 184: Blood and blood productsBlood Cool
Page 185 and 186: Blood and blood productsHaematology
Page 187 and 188: Blood and blood products25322 so th
Page 189 and 190: Blood and blood productsfactors, ha
Page 191 and 192: Day case anaesthesia6. Social crite
Page 193 and 194: ENT anaesthesiaENT anaesthesia{Dr C
Page 195 and 196: ENT anaesthesiaIntraoperative• In
Page 197 and 198: Miscellaneous issuesMiscellaneous i
Page 199 and 200: Miscellaneous issuesideally be cont
Page 201 and 202: Miscellaneous issuesinstruction man
Page 203 and 204: Miscellaneous issuesRemifentanilRem
Page 205 and 206: Miscellaneous issuesCentral neuraxi
Page 207 and 208: Miscellaneous issuesAnalgesia Fenta
Page 209 and 210: Miscellaneous issues• Diclofenac
Page 211 and 212: Miscellaneous issues• Associated
Page 213 and 214: Miscellaneous issues• Everyone wi
Page 215 and 216: Miscellaneous issues• If fasting
Page 217 and 218: Miscellaneous issueslabour ward ana
Page 219 and 220: Miscellaneous issuesThere is no cli
Page 221 and 222: Patient monitoring in and out of th
Page 223 and 224: Miscellaneous issuessuch as Hartman
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Miscellaneous issues• Abdominal a
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Miscellaneous issuesPrevention of p
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Miscellaneous issuesDifferent clini
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Recovery and patient handoverMiscel
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For afternoon list (pm)Diabetic Pat
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Miscellaneous issuestake part in th
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Miscellaneous issuesSee page 37 for
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Waiting list initiatives[Appraised
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Major Incident ProcedureStaff assem
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Major Incident Procedure• In coop
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Finding your way round theUniversit
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• Coffee room.• Quiet room (fiv
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Anaesthesia department lead clinici
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Trust organisational structureTrust
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Telephone numbersLabour ward……
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IndexIndexAabsence, 68adenotonsille
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Indexemergency department, 222emerg
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Indexmortality review, 93MRI scansa
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Indexstudy leave, 81applications, 6
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NotesAnaesthetists Handbook January
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NotesAnaesthetists Handbook January
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