CURRICULUM VITAE Dr. Ike Sri Redjeki, dr., SpAnKIC,KMN,M.Kes •Kepala Departemen Anestesiologi & Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran Bandung •Ketua Program Studi Pendidikan Konsultan Intensive Care (KIC) Fakultas Kedokteran Universitas Padjadjaran Bandung Alamat : Departemen Anestesiologi & Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/RS. Hasan Sadikin Jalan Pasteur no. 38 Bandung 40161 Telp : 022-2038285/0811224046 Fax : 022-2038306 E-mail : [email protected]
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Pain Drug Pharmacology : an UpdatePerioperative Pain management - dr. Ike Sri Redjeki
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CURRICULUM VITAE
Dr. Ike Sri Redjeki, dr., SpAnKIC,KMN,M.Kes• Kepala Departemen Anestesiologi & Terapi Intensif Fakultas
Kedokteran Universitas Padjadjaran Bandung• Ketua Program Studi Pendidikan Konsultan Intensive Care (KIC)
Fakultas Kedokteran Universitas Padjadjaran BandungAlamat : Departemen Anestesiologi & Terapi Intensif Fakultas
Kedokteran Universitas Padjadjaran/RS. Hasan Sadikin Jalan Pasteur no. 38 Bandung 40161Telp : 022-2038285/0811224046Fax : 022-2038306E-mail : [email protected]
Pain Drug Pharmacology : an UpdatePerioperative Pain management
Ike Sri RedjekiRSHS/FK UNPAD
Bandung
Perioperative Pain Management
• Treatment of pain after surgery is central to care of postoperative patients. Failure to relieve pain is morally and ethically unacceptable”
The Royal College of Surgeon of England, The College of Anesthetist, Commission on the Provision of Surgical Services. report on the Working Party on pain After
Surgery 1990
Why postop pain continue to be undermanaged ?
Some Bariers Confusion about who is responsible for postoperative pain
management ? Inadequate knowledge of analgesics (opioid & non-
opioid analgesics) Administration of analgesic is too late, when the patient
complain of pain Using single modality and similar to every surgery
Prostaglandins by themselves do not cause pain but lowerthe threshold of the C fiber nociceptors.
As a result, lower concentrations of bradykinin and histamine are required to activate the nociceptor
Peripheral Sensitization • Sensitization results from the release of bradykinin, prostaglandins,
leukotriene ect alter the type and number of membrane receptors on free nerve endings lowering the threshold for nociceptive stimuli
• The depolarized nociceptive sensory endings release substance P and CGRP along their branches (axon reflex the spread of edema by producing vasodilation, increase in vascular permeability and plasma transvasation, spread of hyperalgesia cause release of histamine from mast cells
• NSAID block the formation of prostaglandins by inhibiting the enzyme cyclooxygenase
• Local anesthetic preferentially blocks C fiber conduction ischemia blocks first the large myelinated fibers
NSAID
• Analgesic, antipyretic • Anti inflammatory - several days dosing
– must dose constantly at least several days – prn not significant anti-inflammatory action
• Onset of action / effect 30 – 60 min• difference in half-life and side effect• NOTE:
– elderly patients should not be on NSAID's with long half-lives – can be even more prolonged in elderly