Practical guide to opioids and ketamine for pain management
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- Опубліковано 28 сер 2024
- This was a focussed lecture for medical students and interns about the more high risk analgesic medications:
we go through
opioids and ketamine:
How to prescribe
What to prescribe for home
What are the risks
How to prevent these complications
How to treat the complications?
When to call the pain registrar
and
some information about ketamine doses and how to problem solve its issues.
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I didn´t know about the option of ketamine for phantom limb pain... thanks for that one! Love your talks!
Sadly no evidence for reducing incidence, just severity…
But epidurals do reduce incidence with a specific pre and post regime
Have you seen any other ways of reducing indicence?
@@ABCsofAnaesthesia no, we usually use regional anesthesia (epidural is considered too invasive for this around here). We might start low-dose antidepressants early, but that´s depending on the hospital treatment standards (and to be honest, I would need to look up the NNT).
Hi I would like to hear what you send total knee replacement patients home with?
Antiemetics: you might consider Dexamethasone and Diphenhydramine/Dimenhydrinate (an H1-Antihistamine), too. Be careful with MCP - especially in parkinson´s disease.
Yes absolutely :) and Watchout all anti dopamines in parkinsons …
Has anyone caused the perianal burning with an accidental rapid infusion of iv dexa?
@@ABCsofAnaesthesia hm.. I normally use it at the beginning of a case when the patient is already sleeping, so no feedback from them at that time ;)
The times I used Dexa in awake patients (either as antiemetic or to extend the duration of a peripheral nerve block) it was no problem. This symptom is very rare and resolves within a minute on its own (according to literature), but nevertheless good to know, Thanks!
Unfortunately the GOE is not good if you´re already nauseous and it takes half an hour to start to work, so its more of an "add on" to the other antiemetics to help you a bit later or as an "Hail Mary" kind of thing.
And I try to avoid MCP at all (and encourage all my colleagues to do so) in favor of Deminhydrinate or 5HT3-antagonists, because of its potential for side-effects. The only times I use it is in ICU when treating GI-motility-disorders.
Really like your talk, lol, bit downplayed by those Med students
thanks so much for the comment Justin :)
Do you have Hydromorphone (Palladon(r)) available? That would be a good alternative for PCIA (or oral) in renal impaired patients as well if oxycodone (Endone(r)) or piritramide is not enough or if you´re afraid of accumulating active metabolites...
Yeah true! We dont use hydromorphone in my hospitals
What dosing regime do you use?
@@ABCsofAnaesthesia I use Hydromorphone (if it´s available in the hospital I work at, not all have it listed) when GFR (according to MDRD or CKD-EPI calculation) is
Oxycodone or hydrocodone
She could have said " Fentanyl"
it's only the bible if you are a man of faith and read the book. nuff said :)