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Analgesia and Pain Management01:25

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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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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.
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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
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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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[Pain management during pregnancy : An expert-based interdisciplinary consensus recommendation].

Daniela Marhofer1, Wolfgang Jaksch2, Thomas Aigmüller3

  • 1Allgemeine Intensivmedizin und Schmerztherapie, Medizinische Universität Wien, Universitätsklinik für Anästhesie, Spitalgasse 23, 1090, Wien, Österreich. daniela.marhofer@meduniwien.ac.at.

Schmerz (Berlin, Germany)
|July 29, 2021
PubMed
Summary
This summary is machine-generated.

Managing pain during pregnancy requires careful consideration of maternal and fetal safety. Non-pharmacological methods are recommended first, with specific medications used cautiously based on the trimester and pain type.

Keywords:
Acute painChronic painMigraineNeuropathic painObstetrical

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Area of Science:

  • Obstetrics and Gynecology
  • Pain Management
  • Pharmacology

Background:

  • Pregnancy and pain present unique challenges for healthcare providers.
  • Maintaining maternal homeostasis and ensuring fetal safety requires careful therapeutic balance.
  • Understanding fetotoxicity and teratogenicity is crucial for safe pain management during pregnancy.

Purpose of the Study:

  • To develop evidence-based drug and non-drug therapy concepts for pain management in pregnant patients.
  • To provide adequate analgesia while prioritizing the safety of the unborn child.

Main Methods:

  • Interdisciplinary expert consensus development.
  • Comprehensive literature review of relevant questions and existing recommendations.
  • Formulation of core treatment statements with assigned recommendation grades.

Main Results:

  • Paracetamol, ibuprofen, diclofenac, metamizole, and opioids can be used cautiously, with NSAIDs requiring extra care in the third trimester.
  • COX-2 inhibitors are not recommended for pain relief in pregnancy.
  • Safe options for neuropathic pain include amitriptyline, duloxetine, and venlafaxine.
  • Non-pharmacological options like TENS therapy, kinesio tapes, and acupuncture are available.
  • Lymphatic drainage is advised for edema not related to preeclampsia.

Conclusions:

  • Pain management during pregnancy should prioritize non-pharmacological interventions.
  • Pharmacological agents can supplement non-drug therapies when necessary.
  • A structured approach ensures optimal pain relief and fetal safety.