Comfort

Nociceptor

Injury to tissues

- Somatic: Sharp, localized sensation

Visceral: Dull, throbbing, aching pain

Neuropathic

Injury to nerves

Opioids receptor for pain management

mu and kappa

Morphine axn

Binds both mu & kappa receptors, produces profound analgesia

Adverse effects of Morphine

N/V, constipation, itching, dysphoria, hallucinations

OD-respiratory depression

C/I of Morphine

avoid etoh and other CNS depressants

Black box warning of Morphine

with epidural route

What is Combined Opioids

Combination analgesics – opioid combine with non-narcotic analgesic

- Work together to relieve pain to avoid narcotic related s/e

naloxone (Narcan) axn

Blocks both mu & kappa receptors for rapid reversal of opioid effects in acute OD.

aspirin COX inhibitor; Salicylate axn

inhibits prostaglandin synthesis to ↓pain and inflammation.

Anticoagulant activity by ↓platelet aggregation (Not Cox-2)

DC 1 week before surgery.

Interactions of NSAIDs

may potentiate oral hypoglycemics → hypoglycemia.

Garlic, ginger, ginkgo and feverfew may ↑risk of bleeding.