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Essentials of Regional Anesthesia pp 617–636Cite as

Acute Pain Management

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Abstract

New studies continue to show the increased risk of morbidity and mortality that is associated with poor or ineffective pain control in postoperative settings. The appropriate technical selection must consider several key factors in addition to the patient’s comorbidities and type of surgery being performed. Furthermore, complications related to neural blockade are rare but not completely avoidable. This chapter reviews various agents and techniques that can be used by physicians utilizing a multimodal analgesic model.

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Acknowledgment

We wish to thank Dr. Ralf E. Gebhard and Dr. Andres Missair for their significant contributions to the first edition of this chapter.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA

    Alan David Kaye MD, PhD

  2. School of Medicine, Louisiana State University Health Sciences Center—New Orleans, New Orleans, LA, USA

    Brooke V. Towne BA

  3. Department of Anesthesiology, Tulane University, New Orleans, LA, USA

    Vibhav B. Reddy MD

  4. Department of Medicine, Louisiana State University Health Sciences Center—New Orleans, New Orleans, LA, USA

    Michael F. Kelley Jr BS

  5. Department of Anesthesiology, Tulane University Hospital and Clinics, New Orleans, LA, USA

    Si Zhang DO

  6. Department of Anesthesiology, Montreal General Hospital, QC, Canada

    Lien Tran MD, FRCPC

  7. Department of Anesthesiology, Louisiana State University Health Sciences Center—Shreveport, Shreveport, LA, USA

    Elyse M. Cornett PhD

  8. Department of Anesthesiology, University of Miami-Miller School of Medicine, Miami, FL, USA

    Ralf E. Gebhard MD

Authors
  1. Alan David Kaye MD, PhD
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  2. Brooke V. Towne BA
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  3. Vibhav B. Reddy MD
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  4. Michael F. Kelley Jr BS
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  5. Si Zhang DO
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  6. Lien Tran MD, FRCPC
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  7. Elyse M. Cornett PhD
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  8. Ralf E. Gebhard MD
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Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    What fraction of the local anesthetic bolus will travel cephalad in a lumbar epidural catheter placed at the L4–L5 interspace in a spontaneously ventilating patient?

    1. (a)

      ½

    2. (b)

      1/3

    3. (c)

      2/3

    4. (d)

      ¾

  2. 2.

    How soon after a patient receives a prophylactic dose of Lovenox is it considered safe to place an epidural?

    1. (a)

      2 h

    2. (b)

      24 h

    3. (c)

      12 h

    4. (d)

      No need to wait

  3. 3.

    What is the maximum INR that is considered safe for epidural placement?

    1. (a)

      1

    2. (b)

      2

    3. (c)

      1.5

    4. (d)

      <1.5

  4. 4.

    The most important factor in determining anesthetic level after an epidural bolus is:

    1. (a)

      Concentration of local anesthetic

    2. (b)

      Volume of local anesthetic

    3. (c)

      Total dose of anesthetic

    4. (d)

      Patient position

  5. 5.

    The most important factor in determining the anesthetic level after a single-shot spinal is:

    1. (a)

      Volume of local anesthetic

    2. (b)

      Concentration of local anesthetic

    3. (c)

      Total dose of anesthetic

    4. (d)

      Baricity of local anesthetic

  6. 6.

    What nerve is typically spared after a single-shot interscalene block?

    1. (a)

      Median nerve

    2. (b)

      Musculocutaneous nerve

    3. (c)

      Radial nerve

    4. (d)

      Ulnar nerve

  7. 7.

    What steps are taken to avoid intravascular injection during nerve blockade?

    1. (a)

      Frequent aspiration before injection

    2. (b)

      Slow injection

    3. (c)

      Avoidance of injections when resistance is encountered

    4. (d)

      Adding epinephrine to the local anesthetic

  8. 8.

    What nerve must be blocked separately to ensure complete neural blockade during an axillary block?

    1. (a)

      Median nerve

    2. (b)

      Ulnar nerve

    3. (c)

      Radial nerve

    4. (d)

      Musculocutaneous nerve

  9. 9.

    A patient received an axillary single-shot nerve block for hand surgery and is complaining of tourniquet pain in the operative arm. Which nerve was missed?

    1. (a)

      Intercostobrachial

    2. (b)

      Musculocutaneous

    3. (c)

      Supraclavicular

    4. (d)

      Ulnar

  10. 10.

    The Bezold–Jarisch reflex is associated with which nerve block?

    1. (a)

      Axillary

    2. (b)

      Infraclavicular

    3. (c)

      Interscalene

    4. (d)

      Interscalene in the sitting position

  11. 11.

    Which local anesthetic has the potential for greatest cardiotoxicity if the dosage is held equal?

    1. (a)

      Lidocaine

    2. (b)

      Mepivacaine

    3. (c)

      Ropivacaine

    4. (d)

      Bupivacaine

  12. 12.

    Which opioid has the lowest incidence of respiratory depression when used for IV PCA?

    1. (a)

      Fentanyl

    2. (b)

      Meperidine

    3. (c)

      Hydromorphone

    4. (d)

      Morphine

  13. 13.

    When switching from IV to PO dosing, what conversion factor is required for hydromorphone?

    1. (a)

      2×

    2. (b)

      3×

    3. (c)

      4×

    4. (d)

      5×

  14. 14.

    Which non-opioid adjuvant exhibits synergy when coadministered with a fentanyl PCA?

    1. (a)

      Aspirin

    2. (b)

      Acetaminophen

    3. (c)

      Dexmedetomidine

    4. (d)

      Clonidine

  15. 15.

    Ketamine can be administered through which routes?

    1. (a)

      IV

    2. (b)

      IM

    3. (c)

      Epidural

    4. (d)

      All of the above

Answers

  1. 1.

    c

  2. 2.

    c

  3. 3.

    d

  4. 4.

    b

  5. 5.

    d

  6. 6.

    d

  7. 7.

    a

  8. 8.

    d

  9. 9.

    a

  10. 10.

    d

  11. 11.

    a

  12. 12.

    a

  13. 13.

    d

  14. 14.

    d

  15. 15.

    d

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Cite this chapter

Kaye, A.D. et al. (2018). Acute Pain Management. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_34

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_34

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74837-5

  • Online ISBN: 978-3-319-74838-2

  • eBook Packages: MedicineMedicine (R0)

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