Riktlinjer för behandling av postoperativ smärta på UMAS
Riktlinjer för behandling av postoperativ smärta på UMAS
Riktlinjer för behandling av postoperativ smärta på UMAS
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Innehålls<strong>för</strong>teckning<br />
Flik Sida<br />
1.<br />
2.<br />
3.<br />
4.<br />
5.<br />
6.<br />
7.<br />
8.<br />
9.<br />
Postoperativ smärt<strong>behandling</strong> vid <strong>UMAS</strong> .................................................................................... 1<br />
Definition <strong>smärta</strong> .......................................................................................................................... 2<br />
Postoperativ smärt<strong>behandling</strong>....................................................................................................... 2<br />
Målsättning och syfte.................................................................................................................... 2<br />
Organisation <strong>av</strong> <strong>postoperativ</strong> smärt<strong>behandling</strong>............................................................................. 3<br />
Generella direktiv (SOSFS 2001:17, 3 kap 9 §) ........................................................................... 3<br />
Förebyggande åtgärder ................................................................................................................. 3<br />
Preoperativ patientinformation ..................................................................................................... 4<br />
Smärtlindring <strong>på</strong> akutmottagningen.............................................................................................. 4<br />
Fördelar med <strong>postoperativ</strong> smärtlindring...................................................................................... 4<br />
Dagkirurgiska patienter................................................................................................................. 5<br />
Smärt<strong>behandling</strong> till patient med <strong>på</strong>gående opioid<strong>behandling</strong> pga långvarig <strong>smärta</strong> .................. 6<br />
Smärttyper..................................................................................................................................... 8<br />
Smärtanalys................................................................................................................................... 8<br />
Smärtskattning .............................................................................................................................. 8<br />
Analgetika delas in i 3 grupper ................................................................................................... 13<br />
Paracetamol................................................................................................................................. 15<br />
Diklofenak .................................................................................................................................. 20<br />
Selektiv COX-2 hämmare........................................................................................................... 24<br />
Tramadol..................................................................................................................................... 25<br />
Dextropropoxifen........................................................................................................................ 27<br />
Kodein + paracetamol (Citodon) ................................................................................................ 28<br />
Postoperativ opioidtill<strong>för</strong>sel........................................................................................................ 30<br />
Morfin/Ketobemidon (Ketogan) ................................................................................................. 30<br />
Antidot/opioider.......................................................................................................................... 37<br />
Oxykodon.................................................................................................................................... 38<br />
Blockad till patienter som är behandlade med opioider.............................................................. 44<br />
Postoperativ smärt<strong>behandling</strong> med EDA (epiduralanalgesi)...................................................... 45<br />
Postoperativ smärt<strong>behandling</strong> med PCA .................................................................................... 56<br />
Postoperativ övervakning efter spinalt administrerade opioider ................................................ 61<br />
Konverteringsguide..................................................................................................................... 65<br />
10. Speciell del<br />
Med dok nr 50 1