Introduction a. Algorithm & annotations




НазваниеIntroduction a. Algorithm & annotations
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VHA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF POSTOPERATIVE PAIN


Veterans Health Administration

Department of Defense


Prepared by:


THE MANAGEMENT OF POSTOPERATIVE PAIN

Working Group


with support from:


The Office of Performance and Quality, VHA, Washington, DC

&

Quality Management Directorate, United States Army MEDCOM


VERSION 1.2

JULY 2001/

UPDATE MAY 2002


VHA/DoD CLINICAL PRACTICE GUIDELINE FOR THE

MANAGEMENT OF POSTOPERATIVE PAIN


TABLE OF CONTENTS


Version 1.2


TABLE OF CONTENTS



INTRODUCTION




A.ALGORITHM & ANNOTATIONS





  • Preoperative Pain Management 1




  • Postoperative Pain Management 2


B.PAIN ASSESSMENT




C.SITE-SPECIFIC PAIN MANAGEMENT





  • Summary Table: Site-Specific Pain Management Interventions 1




  • Head and Neck Surgery 3

  • Ophthalmic Surgery

  • Craniotomies Surgery

  • Radical Neck Surgery

  • Oral-maxillofacial




  • Thorax (Non-cardiac) Surgery 9

  • Thoracotomy

  • Mastectomy

  • Thoracoscopy




  • Thorax (Cardiac) Surgery 16

  • Coronary Artery Bypass Graft (CABG)

  • Minimally Invasive Direct Coronary Artery Bypass (MID-CAB)




  • Upper Abdominal Surgery 19

  • Laparotomy

  • Laparoscopic Cholecystectomy

  • Nephrectomy




  • Lower Abdominal and Pelvis Surgery 26

  • Hysterectomy

  • Radical Retropubic Prostatectomy

  • Inguinal Hernia




  • Back/Spinal Surgery 30

  • Laminectomy

  • Spinal Fusion




  • Surgery of Extremities/Vascular Surgery 33

  • Total Hip Replacement

  • Total Knee Replacement

  • Knee Arthroscopy and Arthroscopic Joint Repair

  • Amputation

  • Shoulder – Open Rotator Cuff Repair or Arthroscopic Sub-Acromial Decompression

  • Vascular Surgery



D.OPTIONS FOR POSTOPERATIVE PAIN MANAGEMENT


NON-PHARMACOLOGIC MANAGEMENT





  • Cognitive Modalities 1

  • Distraction, Relaxation, and Biofeedback

  • Hypnosis




  • Physical Modalities 5

  • Transcutaneous Electrical Nerve Stimulation (TENS)

  • Cold

  • Heat

  • Exercise

  • Positioning

  • Immobilization/Rest

  • Massage

  • Accupuncture


PHARMACOLOGIC MANAGEMENT





  • Routes of Administration 2




  • Pharmacologic Management 9




  • OPIOIDS 9

Summary Table – Site Specific Pain Management Interventions - Opioids

Table OP1 – OPIOIDS: Mechanism of Action, Contraindications, Other Considerations

Table OP2 – OPIOIDS: Dosing and Pharmacokinetics

Table OP2.5 – OPIOIDS: Dosage Formulations

Table OP3 – OPIOIDS: Drug Interactions

Table OP4 – OPIOIDS: Equianalgesic Dosing

Table OP5 – OPIODS: Dosage Formulations


  • Acetaminophen and NSAIDs 49

Summary Table – Site Specific Pain Management Interventions - NSAIDs

Table NS1 – NSAIDs: Mechanism of Action, Contraindications, Other Considerations

Table NS2 – NSAIDs: Dosing and Pharmacokinetics

Table NS3 – NSAIDs: Drug Interactions


  • Local Anesthetics 62

Summary Table – Site Specific Pain Management Interventions– Local Anesthetics

Table LA1 – Local Anesthetics: Mechanism of Action, Contraindications, Other considerations

Table LA2 – Local Anesthetics: Pharmacologic, Pharmacokinetic, and Clinical Characteristics

Table LA3 – Local Anesthetics: Adverse Effects


  • Glucocorticoids 72

Summary

Table GC1 – Comparison of glucocorticoid agents in order of increasing potency and duration.

Table GC2 – Dosing and routes of administration of glucocorticoids with postoperative analgesic efficacy

Table GC3 – Dosing and administration of glucocorticoids fpr [pstoperative and e[idural morphine-related nausea or vomiting
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