Hammam Akbik, M'D'

1
My Chest hurts, Can you Help me?

• Hammam Akbik, M.D.
• Chief, Pain Medicine Division
• Assistant Professor of Anesthesiology
• University of Cincinnati

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I am going to have surgery,Am I going to feel
Pain?
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What is, Post thoracotomy
Post Pleurodesis chest pain

• Long-term postoperative wound pain is a potential
  morbidity of thoracic surgery the cause of
  persistent pain after thorocotomy is
  multifactorial but includes
• tissue destruction,
• intercostal nerve trauma,
• scar formation,
• rib fractures,
• costochondral separation.

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Incidence

• 25 of patient may experience pain after thoracic
  surgery, pain that is aggravated by respiration
  and coughing. Pain may be further exacerbated by
  the presence of chest tubes and drains.
• Thoracotomy pain is generally moderate to severe,
  lasting weeks.
• Patients may develop post-thoracotomy pain
  syndromes lasting months to years

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How can I describe it ?
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Treatment

• Preventive Pre-emptive pain control
• Medication
• Intervention
• Peri-operative
• Post operative
• Long term

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Pre-Emptive Analgesia

• Medications
• Tylenol
• Celebrex
• Neurontin
• Oxycodon
• Epidural
• Continuous
• EPCA Patient-Controlled Analgesia (EPCA)

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Medications

• Intravenous
• Opioids
• Bolus
• Infusion
• PCA

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Medications

• Oral
• Opioids
• Long acting
• Short Acting
• NSAIDs
• Acetaminophen
• Anti Epileptics
• Local
• Cream
• Patch

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Intra/ Sub-Pleural Catheter

• Continuous
• Bolus

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Sub/ Inter costal Nerve blocks

• Local Anesthetics
• Steroids
• Alcohol
• Phenol
• Radiofrequency
• Cryotherapy

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Epidural port-A-Cath

• Short term 0-6 month
• External bag
• Daily care

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Paravertebral blocks

• Single shot
• Continuous

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Intra wound Catheter

• Short term 0-6 days
• Easy care
• Self D/C

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Transcutenous Electrical Nerve Stimulation (TENS)
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Implantable Devices

• Intra Thechal Delivery Device System IDDS
• Spinal Cord Stimulators - SCS