Handbook of Acute Pain Management

338 Pages·2010·3.15 MB·English

Handbook of Acute Pain Management E
l
l
i
o
About the book About the editors
t
t

Pain is a pervasive symptom in medicine. It is JENNIFER A. ELLIOTT, M.D., Associate Professor, •
imperative that physicians not only evaluate University of Missouri–Kansas City School of
S
and diagnose the source of pain, but that they Medicine, Kansas City, Missouri. Dr. Elliott is a m
also recognize how to manage the actual pain Physician at Saint Luke’s Hospital of Kansas City. A
symptoms with effective treatment. Addressing certified Anesthesiologist and Pain Management i
t
the latest developments in both pharmacologic specialist, Dr. Elliott is the author of multiple h
and non-pharmacologic pain therapies, this text publications concerning pharmacologic pain
is a useful reference for all those administering to therapies. She is a member of numerous medical
patients with acute pain. organizations including the American Society of
Anesthesiologists and the American Academy of
This easy to use handbook covers: Pain Medicine. H
• Important background on the anatomy and a
neurobiology of pain HOWARD S. SMITH, M.D., F.A.C.P., Associate n
Professor, Albany Medical College, Albany,
• The most up-to-date information on d
New York. Dr. Smith is the Academic Director
pharmacologic treatments including local
of Pain Management at the Albany Medical b
anesthetics, NSAIDS, alpha-2 agonists, and
opioids College‘s Department of Anesthesiology. He is o Handbook of
certified in Internal Medicine, Nuclear Medicine,
o
• Potential drug-drug and drug-disease Anesthesiology, Palliative Medicine, Addiction
interactions Medicine, and Pain Management. Dr. Smith k
• The most up-to-date information on non- is a widely published expert in the field of o
pharmacologic treatment like continuous Pain Medicine. A member of many medical Acute Pain
catheter techniques and other injection-based organizations, Dr. Smith is a fellow of the American f
therapies College of Physicians and the American College A
of Nuclear Physicians.
• Patient-controlled analgesia options c
u
• Anticoagulation guidelines during regional Management
and neuraxial anesthetic techniques t
e
• Pain management issues in special

populations – specifically pediatric, opioid- P
tolerant, obstetric, trauma, and elderly a
patients
i
n

M
a
n
a
g
e
m
e
n
t
Edited by
Jennifer A. Elliott
Howard S. Smith
[Vinit][D:/informa_Publishing/Elliott_2400062/z_production/z_3B2_3D_files/978-0-
7890-3168-6_CH0000_O.3d][21/11/010/13:20:8][1–12]
Handbook of Acute
Pain Management
[Vinit][D:/informa_Publishing/Elliott_2400062/z_production/z_3B2_3D_files/978-0-
7890-3168-6_CH0000_O.3d][21/11/010/13:20:8][1–12]
[Vinit][D:/informa_Publishing/Elliott_2400062/z_production/z_3B2_3D_files/978-0-
7890-3168-6_CH0000_O.3d][21/11/010/13:20:8][1–12]
Handbook of Acute
Pain Management
Edited by
Jennifer A. Elliott
Department of Anesthesiology
University of Missouri–Kansas City School of Medicine
and Saint Luke’s Hospital of Kansas City
Kansas City, Missouri, U.S.A.
Howard S. Smith
Department of Anesthesiology and Pain Management
Albany Medical College
Albany, New York, U.S.A.
[Vinit][D:/informa_Publishing/Elliott_2400062/z_production/z_3B2_3D_files/978-0-
7890-3168-6_CH0000_O.3d][21/11/010/13:20:8][1–12]
Publishedin2011byInformaHealthcare,TelephoneHouse,69-77PaulStreet,LondonEC2A4LQ,UK.
Simultaneously published in the USA by Informa Healthcare, 52 Vanderbilt Avenue, 7th floor,
NewYork,NY10017,USA.
#2011InformaUKLtd,exceptasotherwiseindicated.
NoclaimtooriginalU.S.Governmentworks.
Reprintedmaterialisquotedwithpermission.Althougheveryefforthasbeenmadetoensurethat
allownersofcopyrightmaterialhavebeenacknowledgedinthispublication,wewouldbegladto
acknowledgeinsubsequentreprintsoreditionsanyomissionsbroughttoourattention.
Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,or
transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or
otherwise, unless with the prior written permission of the publisher or in accordance with the
provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence
permittinglimitedcopyingissuedbytheCopyrightLicensingAgency,90TottenhamCourtRoad,
LondonW1P0LP,UK,ortheCopyrightClearanceCenter,Inc.,222RosewoodDrive,Danvers,MA
01923,USA(http://www.copyright.com/ortelephone978-750-8400).
Productorcorporatenamesmaybetrademarksorregisteredtrademarks,andareusedonlyfor
identificationandexplanationwithoutintenttoinfringe.
Thisbookcontainsinformationfromreputablesourcesandalthoughreasonableeffortshavebeen
made to publish accurate information, the publisher makes no warranties (either express or
implied) as to the accuracy or fitness for a particular purpose of the information or advice
containedherein.Thepublisherwishestomakeitclearthatanyviewsoropinionsexpressedinthis
book by individual authors or contributors are their personal views and opinions and do not
necessarilyreflecttheviews/opinionsofthepublisher.Anyinformationorguidancecontainedin
thisbookisintendedforusesolelybymedicalprofessionalsstrictlyasasupplementtothemedical
professional’sownjudgement,knowledgeofthepatient’smedicalhistory,relevantmanufacturer’s
instructionsandtheappropriatebestpracticeguidelines.Becauseoftherapidadvancesinmedical
science,anyinformationoradviceondosages,procedures,ordiagnosesshouldbeindependently
verified.Thisbookdoesnotindicatewhetheraparticulartreatmentisappropriateorsuitablefora
particularindividual.Ultimatelyitisthesoleresponsibilityofthemedicalprofessionaltomakehis
orherownprofessionaljudgements,soasappropriatelytoadviseandtreatpatients.Savefordeath
or personal injury caused by the publisher’s negligence and to the fullest extent otherwise
permittedbylaw,neitherthepublishernoranypersonengagedoremployedbythepublishershall
beresponsibleorliableforanyloss,injuryordamagecausedtoanypersonorpropertyarisingin
anywayfromtheuseofthisbook.
ACIPrecordforthisbookisavailablefromtheBritishLibrary.
ISBN-13:978-0-7890-3168-6
Ordersmaybesentto:InformaHealthcare,SheepenPlace,Colchester,EssexCO33LP,UK
Telephone:[phone]
Email:[email protected]
Website:http://informahealthcarebooks.com/
Forcorporatesalespleasecontact:[email protected]
Forforeignrightspleasecontact:[email protected]
Forreprintpermissionspleasecontact:[email protected]
TypesetbyMPSLimited,aMacmillanCompany
PrintedandboundintheUnitedKingdom
[Vinit][D:/informa_Publishing/Elliott_2400062/z_production/z_3B2_3D_files/978-0-
7890-3168-6_CH0000_O.3d][21/11/010/13:20:8][1–12]
Iwouldliketodedicatethisbooktomyparents,DavidE.andChristelM.Elliott,and
my husband, Michael J. Bell, who have provided much guidance, unconditional love
andsupport,and theinspiration to completethis book.
Iwouldalsoliketogivethankstothemanycontributorsfortheirtimeandeffort,
aswellasDeanShepardforhisassistancewithcreatingmanyofthefiguresandtables
inthisbook.
J.A.E.
v
[Vinit][D:/informa_Publishing/Elliott_2400062/z_production/z_3B2_3D_files/978-0-
7890-3168-6_CH0000_O.3d][21/11/010/13:20:8][1–12]
[Vinit][D:/informa_Publishing/Elliott_2400062/z_production/z_3B2_3D_files/978-0-
7890-3168-6_CH0000_O.3d][21/11/010/13:20:8][1–12]
Preface
Pain is a universal experience and is the most frequent reason people seek medical
attention. Medical students and residents receive comprehensive guidance in the
evaluationanddiagnosisofthesourceofpaincomplaints,yetformaleducationonthe
topic of pain symptom management has not traditionally been offered in medical
training,leavingmanycliniciansuncomfortablewithprovidingtreatmentforpain.Pain
cantherefore become‘‘painful’’ tothe treating practitioner aswellasthe patient.This
book is intended to assist clinicians who are called upon to treat the patient in acute
pain by enhancing their knowledge of and comfort with pain therapies. The scope of
providerswhomaybeinapositiontomanagetheacutepainpatientiswideranging,
from medical students and residents to primary care providers, as well as anesthesi-
ologists, neurologists, physiatrists, andother specialists.
Thisbookwillprovidethereaderwithbackgroundinformationontheanatomy
and neurobiology of pain to lay a foundation for the understanding of pain patho-
physiology. Pharmacologic approaches to acute pain management are thoroughly
covered, including the use of local anesthetics, NSAIDS, opioids, and a agonists.
2
Patient-controlledanalgesiaoptionsincludingpatient-controlledepiduralanalgesiaare
alsoexplored.Nonpharmacologicandinterventionalanesthetictechniquesarecovered,
including the use of continuous catheter techniques for postoperative pain manage-
ment. A chapter also reviews information about anticoagulation guidelines when
considering the use of regional and neuraxial anesthetic techniques. Finally, a discus-
sion of pain management issues in special populations such as pediatric, obstetric,
trauma,opioid-tolerant, andelderly patients isprovided.
The material in this book is intended to provide an up-to-date look at the
emergingtreatmentstrategiesinthecontinuouslyexpandingfieldofpainmanagement
and is accompanied by numerous figures and tables to give an at-a-glance review of
important concepts discussed in the text. This text provides expanded information on
topics such as opioids, including potential drug-drug and drug-disease interactions,
which cannot readily be found in other similar texts currently on the market. It also
highlights the evolution of new technologies such as ‘‘smart’’ patient-controlled anal-
gesia devices along with associated safety innovations. Information on new develop-
ments in the field of regional anesthesia, especially the emergence of continuous
catheter techniques, is included to bring the reader up to date on the latest available
injection-based therapies.
My goal is that readers will find this book to be a user-friendly reference that
addresses the most recent developments in the management of pain. I hope this will
assistreadersintheapproachtothepatientsufferingacutepainandwillenhancetheir
levelofcomfort as wellasthatof theirpatients.
Jennifer A.Elliott
vii
[Vinit][D:/informa_Publishing/Elliott_2400062/z_production/z_3B2_3D_files/978-0-
7890-3168-6_CH0000_O.3d][21/11/010/13:20:8][1–12]
[Vinit][D:/informa_Publishing/Elliott_2400062/z_production/z_3B2_3D_files/978-0-
7890-3168-6_CH0000_O.3d][21/11/010/13:20:8][1–12]
Contents
Preface. ...vii
Contributors.. ..xi
1. Theanatomy ofpostoperative pain 1
Jun-MingZhang
2. Theneurobiology ofacute pain 10
EugeneE.Fibuch and JohnQ. Wang
3. Localanestheticsinthemanagementofacutepostoperativepain 19
GaryMcCleane
4. NSAIDs inthe managementofacute pain 28
JenniferA.Elliott, Eugene E.Fibuch,and Laura Textor
5. Opioidsin the managementofacutepain 73
JenniferA.Elliott
6. Patient-controlled analgesia inthe managementofacute pain 110
JenniferA.Elliott
7. Authorized agentcontrolledanalgesia 128
LauraTextor
8. a Agonists in the managementofacute pain 134
2
JenniferA.Elliott and HowardS. Smith
9. Nonpharmacological modalities for the
treatmentofacute pain 154
LauraTextor
10. Perioperative epidural analgesia
andpatient-controlled epidural analgesia 173
SonaliAgarwal andSudhir Diwan
11. Upper-extremity regional anesthetic techniques inthe
managementofpostoperative pain 184
JamesRasinsky
12. Lower-extremityregional anesthetic techniques inthe
managementofpostoperative pain 198
J.Mark Matthews
ix