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Related Concept Videos

Analgesia and Pain Management01:25

Analgesia and Pain Management

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Drug Delivery: Parenteral Route01:29

Drug Delivery: Parenteral Route

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The parenteral route is a critical method of drug administration. It delivers compounds directly into the systemic circulation and bypasses the gastrointestinal tract. This approach is particularly advantageous for drugs that exhibit poor absorption or instability when administered orally.
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
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Peripheral Artery Disease V: Postoperative Nursing Management01:23

Peripheral Artery Disease V: Postoperative Nursing Management

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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices

Timothy R Deer1, Jason E Pope2, Salim M Hayek3

  • 1Center for Pain Relief, Charleston, WV, USA.

Neuromodulation : Journal of the International Neuromodulation Society
|January 3, 2017
PubMed
Summary

The Polyanalgesic Consensus Conference (PACC) developed new algorithms for intrathecal drug delivery, enhancing patient-centric, safety-based pain management. These evidence-based guidelines improve care for various pain types.

Keywords:
Chronic painconsensusfixed rate pumpintrathecal drug deliveryneuropathic painnonmalignant painopioidprogrammable pumppsychological evaluationsafety

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Area of Science:

  • Neuromodulation
  • Pain Management
  • Evidence-Based Medicine

Background:

  • The International Neuromodulation Society established the Polyanalgesic Consensus Conference (PACC) in 2007 to guide pain treatment practices.
  • Previous PACC guidelines were published in 2012, necessitating an update to address advancements and shortcomings.

Purpose of the Study:

  • To update clinical practice guidelines for intrathecal drug delivery.
  • To develop evidence-based algorithms for managing nociceptive and neuropathic pain.
  • To incorporate innovations and address deficiencies in pain management since 2012.

Main Methods:

  • An extensive literature search was conducted for publications between January 2007 and November 2015.
  • A panel of experts reviewed literature, determined evidence levels, and established degrees of recommendation for intrathecal therapy.
  • Consensus development, ranked as strong, moderate, or weak, informed algorithm creation for intrathecal medication choices.

Main Results:

  • New algorithms were developed for intrathecal medication selection in patients with cancer, terminal illness, and non-cancer pain.
  • Algorithms address both localized and diffuse pain, encompassing nociceptive and neuropathic types.
  • Thirty-one consensus points were established, integrating expert opinion to fill evidence gaps.

Conclusions:

  • The PACC has created an algorithmic process for intrathecal drug delivery, promoting safe and effective care.
  • New guidance and algorithms are established to enhance patient outcomes with intrathecal drug delivery.