Table Of Content

PPrrooffeessssoorr NNaarriinnddeerr RRaawwaall,, MMDD,, PPhhDD,, FFRRCCAA ((HHoonn)) DDeeppaarrttmmeenntt ooff CClliinniiccaall MMeeddiicciinnee DDiivviissiioonn ooff AAnnaaeesstthheessiioollooggyy aanndd IInntteennssiivvee CCaarree UUnniivveerrssiittyy HHoossppiittaall ÖÖrreebbrroo,, SSwweeddeenn PPeerrssiisstteenntt ppoossttssuurrggiiccaall ppaaiinn  MMMMeeeecccchhhhaaaannnniiiissssmmmm –––– ppppaaaatttthhhhoooopppphhhhyyyyssssiiiioooollllooooggggyyyy  PPPPrrrreeeevvvvaaaalllleeeennnncccceeee  RRRRiiiisssskkkk ffffaaaaccccttttoooorrrrssss  RRRRoooolllleeee ooooffff ssssuuuurrrrggggiiiiccccaaaallll tttteeeecccchhhhnnnniiiiqqqquuuueeee  IIIIssssssssuuuueeee ooooffff uuuunnnnnnnneeeecccceeeessssssssaaaarrrryyyy ssssuuuurrrrggggeeeerrrryyyy  CCCCaaaannnn ppppeeeerrrrssssiiiisssstttteeeennnntttt ppppoooossssttttssssuuuurrrrggggiiiiccccaaaallll ppppaaaaiiiinnnn bbbbeeee pppprrrreeeevvvveeeennnntttteeeedddd???? TTTThhhheeee rrrroooolllleeee ooooffff aaaannnnaaaallllggggeeeessssiiiicccc tttteeeecccchhhhnnnniiiiqqqquuuueeeessss 1111.... LLLLooooccccaaaallll aaaannnndddd ssssyyyysssstttteeeemmmmiiiicccc cccchhhheeeemmmmiiiiccccaaaallllssss ddddrrrriiiivvvveeee ppppaaaaiiiinnnn ssssiiiiggggnnnnaaaalllllllliiiinnnngggg 2222.... NNNNeeeeuuuurrrroooommmmaaaa aaaatttt iiiinnnnjjjjuuuurrrryyyy ssssiiiitttteeee ---- eeeexxxxcccciiiittttaaaabbbbiiiilllliiiittttyyyy iiiinnnn sssseeeennnnssssoooorrrryyyy ffffiiiibbbbrrrreeeessss 3333.... CCCChhhhaaaannnnggggeeeessss iiiinnnn ggggeeeennnneeee eeeexxxxpppprrrreeeessssssssiiiioooonnnn iiiinnnn ddddoooorrrrssssaaaallll ffffrrrroooonnnntttt ggggaaaannnngggglllliiiioooonnnn 4444.... DDDDoooorrrrssssaaaallll hhhhoooorrrrnnnn ---- cccceeeennnnttttrrrraaaallll sssseeeennnnssssiiiittttiiiizzzzaaaattttiiiioooonnnn 5555.... DDDDeeeesssscccceeeennnnddddiiiinnnngggg ccccoooonnnnttttrrrroooollllssss mmmmoooodddduuuullllaaaatttteeee ttttrrrraaaannnnssssmmmmiiiissssssssiiiioooonnnn iiiinnnn ssssppppiiiinnnnaaaallll ccccoooorrrrdddd 6666.... LLLLiiiimmmmbbbbiiiicccc ssssyyyysssstttteeeemmmm aaaannnndddd hhhhyyyyppppooootttthhhhaaaallllaaaammmmuuuussss ---- aaaalllltttteeeerrrreeeedddd mmmmoooooooodddd,,,, bbbbeeeehhhhaaaavvvviiiioooouuuurrrr 7777.... SSSSeeeennnnssssaaaattttiiiioooonnnn ooooffff ppppaaaaiiiinnnn ggggeeeennnneeeerrrraaaatttteeeedddd iiiinnnn ccccoooorrrrtttteeeexxxx ((((ppppaaaasssstttt eeeexxxxppppeeeerrrriiiieeeennnncccceeeessss,,,, ccccuuuullllttttuuuurrrraaaallll iiiinnnnppppuuuuttttssss,,,, eeeexxxxppppeeeeccccttttaaaattttiiiioooonnnnssss)))) 8888.... GGGGeeeennnnoooommmmiiiicccc DDDDNNNNAAAA pppprrrreeeeddddiiiissssppppoooosssseeee ((((oooorrrr nnnnooootttt)))) ppppaaaattttiiiieeeennnntttt ffffoooorrrr cccchhhhrrrroooonnnniiiicccc ppppaaaaiiiinnnn PPeerrssiisstteenntt ppoossttssuurrggiiccaall ppaaiinn –– tthhee iinncciiddeennccee  CCCCrrrraaaannnniiiioooottttoooommmmyyyy 6666----11112222 %%%% KKKKaaaauuuurrrr 2222000000000000 HHHHaaaarrrrnnnneeeerrrr 1111999999993333  LLLLeeeegggg aaaammmmppppuuuuttttaaaattttiiiioooonnnn 55550000----88880000 %%%% FFFFiiiinnnncccchhhh 1111999988880000 FFFFiiiisssshhhheeeerrrr 1111999999998888 SSSShhhheeeerrrrmmmmaaaannnn 1111999988884444  TTTThhhhoooorrrraaaaccccoooottttoooommmmyyyy 55550000 %%%% BBBBeeeerrrrttttrrrraaaannnndddd 1111999999996666 KKKKaaaattttzzzz 1111999999996666  BBBBrrrreeeeaaaasssstttt ssssuuuurrrrggggeeeerrrryyyy 11111111----55557777 %%%% JJJJuuuunnnngggg 2222000000003333 TTTTaaaassssmmmmuuuutttthhhh 1111999999996666  LLLLaaaapppp cccchhhhoooolllleeeeccccyyyysssstttteeeeccccttttoooommmmyyyy 3333----55556666 %%%% SSSSttttiiiiffffffff 1111999999994444 UUUUrrrreeee 1111999999995555 ddddeeee PPPPoooovvvvoooouuuurrrrvvvviiiilllllllleeee 1111999999997777  IIIInnnngggguuuuiiiinnnnaaaallll hhhheeeerrrrnnnniiiiaaaa 11112222 %%%% AAAAaaaassssvvvvaaaannnngggg 2222000000005555 CChhrroonniicc ppoossttssuurrggiiccaall ppaaiinn SSuurrggiiccaall •• SSeevveerriittyy ooff ppoossttooppeerrttaaiivvee Genetic predisposition ppaaiinn •• SSuurrggiiccaall ffaaccttoorrss -- ssiittee aanndd eexxtteenntt ooff ssuurrggeerryy -- ddaammaaggee ttoo nneerrvveess -- rreeooppeerraattiioonnss -- bblleeeeddiinngg,, iinnffeeccttiioonn Psychological • Patient attiudes Preoperative • Preop anxiety • Expectation of • Female gender chronicity Environmental • Younger age • Poor education • Pain before surgery • Low income • Analgesic use • Poor self-rated health DDiiffffeerreenntt ppaaiinn ssyynnddrroommeess aafftteerr ssaammee ssuurrggeerryy** •••• LLLLoooowwwweeeerrrr lllliiiimmmmbbbb aaaammmmppppuuuuttttaaaattttiiiioooonnnn ---- pppphhhhaaaannnnttttoooommmm ppppaaaaiiiinnnn ---- ssssttttuuuummmmpppp ppppaaaaiiiinnnn ---- bbbbaaaacccckkkk ppppaaaaiiiinnnn •••• BBBBrrrreeeeaaaasssstttt ssssuuuurrrrggggeeeerrrryyyy ---- pppphhhhaaaannnnttttoooommmm ppppaaaaiiiinnnn ---- nnnneeeeuuuurrrrooooppppaaaatttthhhhiiiicccc ppppaaaaiiiinnnn ((((ddddaaaammmmaaaaggggeeee ttttoooo iiiinnnntttteeeerrrrccccoooossssttttoooobbbbrrrraaaacccchhhhiiiiaaaallll nnnneeeerrrrvvvveeee)))) ---- ssssccccaaaarrrr ppppaaaaiiiinnnn ** PPaattiieennttss mmaayy ccoommppllaaiinn ooff aa rraannggee ooff uunnpplleeaassaanntt ssyymmppttoommss aafftteerr ssuurrggeerryy ssuucchh aass nnuummbbnneessss,, ttiinngglliinngg,, sswweelllliinngg ppaaiinn ´´ IItt ss nnoott oonnllyy nneerrvvee ddaammaaggee """"DDDDaaaammmmaaaaggggeeee ttttoooo nnnneeeerrrrvvvveeeessss dddduuuurrrriiiinnnngggg ssssuuuurrrrggggeeeerrrryyyy iiiissss oooobbbbvvvviiiioooouuuussssllllyyyy aaaannnn iiiimmmmppppoooorrrrttttaaaannnntttt ccccaaaauuuusssseeee ooooffff cccchhhhrrrroooonnnniiiicccc ppppaaaaiiiinnnn aaaafffftttteeeerrrr ssssuuuurrrrggggeeeerrrryyyy -------------------- bbbbuuuutttt tttthhhhiiiissss iiiissss aaaa ccccoooommmmpppplllleeeexxxx iiiissssssssuuuueeee.... MMMMeeeerrrreeeellllyyyy aaaavvvvooooiiiiddddiiiinnnngggg tttthhhheeee sssseeeeccccttttiiiioooonnnniiiinnnngggg ooooffff mmmmaaaajjjjoooorrrr nnnneeeerrrrvvvveeee ttttrrrruuuunnnnkkkkssss iiiissss nnnnooootttt ssssuuuuffffffffiiiicccciiiieeeennnntttt ttttoooo pppprrrreeeevvvveeeennnntttt CCCCPPPPSSSSPPPP aaaannnndddd sssseeeeccccttttiiiioooonnnniiiinnnngggg nnnneeeerrrrvvvveeeessss cccclllleeeeaaaarrrrllllyyyy ddddooooeeeessss nnnnooootttt aaaallllwwwwaaaayyyyssss rrrreeeessssuuuulllltttt iiiinnnn cccchhhhrrrroooonnnniiiicccc ppppaaaaiiiinnnn.... IIIItttt iiiissss nnnnooootttt ppppoooossssssssiiiibbbblllleeee ttttoooo ppppeeeerrrrffffoooorrrrmmmm ooooppppeeeerrrraaaattttiiiioooonnnnssss wwwwiiiitttthhhhoooouuuutttt iiiinnnnjjjjuuuurrrriiiinnnngggg eeeelllleeeemmmmeeeennnnttttssss ooooffff tttthhhheeee nnnneeeerrrrvvvvoooouuuussss ssssyyyysssstttteeeemmmm aaaatttt ssssoooommmmeeee lllleeeevvvveeeellll"""" MMaaccrraaee WW AA BBrr JJ AAnnaaeesstthh 22000088;;11000011::7777--8866 CCCChhhhlllloooorrrrooooffffoooorrrrmmmm hhhhaaaassss ddddoooonnnneeee aaaa ggggrrrreeeeaaaatttt ddddeeeeaaaallll ooooffff hhhhaaaarrrrmmmm.... IIIItttt aaaalllllllloooowwwwssss aaaannnnyyyy ffffoooooooollll ttttoooo bbbbeeee aaaa ssssuuuurrrrggggeeeeoooonnnn.... GGGGeeeeoooorrrrggggeeee BBBBeeeerrrrnnnnaaaarrrrdddd SSSShhhhaaaawwww IIIInnnn:::: AAAA ddddooooccccttttoooorrrr''''ssss ddddiiiilllleeeemmmmmmmmaaaa 1111999900006666 PPeerrssiisstteenntt ppoossttssuurrggiiccaall ppaaiinn –– rroollee ooff ssuurrggiiccaall tteecchhnniiqquuee  LLLLaaaappppaaaarrrraaaassssccccooooppppiiiicccc ssssuuuurrrrggggeeeerrrryyyy ((((vvvvssss.... ooooppppeeeennnn))))  MMMMaaaasssstttteeeeccccttttoooommmmyyyy ---- pppprrrreeeesssseeeerrrrvvvvaaaattttiiiioooonnnn ooooffff iiiinnnntttteeeerrrrccccoooossssttttaaaallll----bbbbrrrraaaacccchhhhiiiiaaaallll nnnneeeerrrrvvvveeee ---- sssseeeennnnttttiiiinnnneeeellll llllyyyymmmmpppphhhh nnnnooooddddeeee bbbbiiiiooooppppssssyyyy ((((aaaavvvvooooiiiiddddssss aaaaxxxxiiiillllllllaaaarrrryyyy ddddiiiisssssssseeeeccccttttiiiioooonnnn aaaannnndddd iiiinnnntttteeeerrrrccccoooossssttttaaaallll nnnneeeerrrrvvvveeee ddddaaaammmmaaaaggggeeee))))  TTTThhhhoooorrrraaaaccccoooossssccccooooppppiiiicccc tttteeeecccchhhhnnnniiiiqqqquuuueeeessss ((((ssssppppaaaarrrreeee iiiinnnntttteeeerrrrccccoooossssttttaaaallll nnnneeeerrrrvvvveeeessss)))) aaaavvvvooooiiiidddd uuuusssseeee ooooffff rrrriiiibbbb rrrreeeettttrrrraaaaccccttttoooorrrrssss ---- iiiinnnntttteeeerrrrccccoooossssttttaaaallll ssssuuuuttttuuuurrrreeee tttteeeecccchhhhnnnniiiiqqqquuuueeee ttttoooo aaaavvvvooooiiiidddd nnnneeeerrrrvvvveeee ccccoooommmmpppprrrreeeessssssssiiiioooonnnn  MMMMuuuusssscccclllleeee ssssppppaaaarrrriiiinnnngggg tttthhhhoooorrrraaaaccccoooottttoooommmmyyyy  MMMMiiiinnnniiiimmmmaaaallllllllyyyy iiiinnnnvvvvaaaassssiiiivvvveeee ssssuuuurrrrggggeeeerrrryyyy ((((nnnneeeepppphhhhrrrreeeeccccttttoooommmmyyyy,,,, sssstttteeeerrrrnnnnoooottttoooommmmyyyy eeeettttcccc....)))) AAnnnn TThhoorraacc SSuurrgg 22000033;;7766::440077--1122  EEEElllleeeeccccttttiiiivvvveeee tttthhhhoooorrrraaaaccccoooottttoooommmmyyyy,,,, nnnn ==== 222288880000,,,, ssssiiiinnnngggglllleeee ssssuuuurrrrggggeeeeoooonnnn  PPPPrrrreeeeooooppppeeeerrrraaaattttiiiivvvveeee EEEEDDDDAAAA  PPPPeeeerrrriiiiccccoooossssttttaaaallll ssssuuuuttttuuuurrrreeeessss ((((ssssttttiiiittttcccchhhheeeessss oooonnnn ttttoooopppp ooooffff 5555tttthhhh aaaannnndddd 7777tttthhhh rrrriiiibbbb ((((nnnn ==== 111144440000)))) vvvvssss.... iiiinnnnttttrrrraaaaccccoooossssttttaaaallll ssssuuuuttttuuuurrrreeeessss ((((ssssttttiiiittttcccchhhheeeessss oooonnnn ttttoooopppp oooonnnnffff 5555tttthhhh rrrriiiibbbb aaaannnndddd tttthhhhrrrroooouuuugggghhhh 6666tttthhhh rrrriiiibbbb ((((nnnn ==== 111144440000))))  PPPPaaaaiiiinnnn ssssccccoooorrrreeeessss lllloooowwwweeeerrrr iiiinnnn iiiinnnnttttrrrraaaaccccoooossssttttaaaallll ggggrrrroooouuuupppp aaaatttt 2222 wwwweeeeeeeekkkkssss,,,, 1111 mmmmoooonnnntttthhhh,,,, 2222 mmmmoooonnnntttthhhhssss,,,, 3333 mmmmoooonnnntttthhhhssss

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Division of Anaesthesiology and Intensive Care Lap cholecystectomy. 3-56 % .. Pain management routines integrated into surgical clinical pathways.

Professor Narinder Rawal, MD, PhD, FRCA (Hon) - AKUTNE.CZ PDF

43 Pages·2011·1.49 MB·English

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Division of Anaesthesiology and Intensive Care Lap cholecystectomy. 3-56 % .. Pain management routines integrated into surgical clinical pathways.

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