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APPENDIX VI: PAIN MANAGEMENT 881
tives [Q oral, tmravenous, or intramuscular drug delivery for pain are
descnbed in Tables VI-4-VI-6. Communication among therapists,
nurses, physicians, and patients on the effectiveness of pain managemenr is essential [Q maximize the patient's comfort. This includes a thorough review of the patient's medical history and the doctor's
orders by the physical therapist before prescribing any modalities or
therapeutic exercises.
Table VI-3. Systemic Op.oids
Indicanon:
Moderate to severe postoperarive pain, can also be used preoperatively
Mechanism of action:
Blocks tran�mission of pain from the spinal cord to the cerebrum by
imeractmg with opioid receptors
Can he adminlsrered orally, IIlrravenously, IIlrramuscularly, subcutaneously,
and imrathecally
General side effecrs:
Decreased gastrointestinal morility, nausea, vomiting, and cramps
Mood changes and sedarion
Prurirus (itchmg)
Unnary retention
Respirarory and cough depression
Pupillary consmetlon
Medications: Generic name (trade name)
Allentanol hydrochloride (Allenta, Rapilen)
Buprenorphllle (Buprenex, Temgesic)
Butorphanol (Stadol)
Codeine (Paveral)
Dezocine (Dalg.n)
Fentanyl (Sublam,"e)
Fentanyl transdermal (Duragesic)
Ilydromorphone (D.I.udid, CD Palladone)
Levorphanol (Dromoran, Levorphan)
Meperidlllc (Demerol, CD Pamergan, CD Pethidine)
Methadone (Dolophinc, Merhadose, Physcprone)
Morphine (MS Contin, Roxanol, Anamorph, Astramorph, Morcap,
Duramorph, Epimorph, Infumorph, Oramorph, Rescudose, Starex)
N.lbuphone (Nubaon)
Naloxone (Narcan)
Oxycodonc (Roxicodone, Supeudol, Endodan, Tylox, Percocet, Percodan)
Oxymorphone (Nulllorphan)
Pentazocine (Fortral, Talwin)
882 ACUTE CARE HANDBOOK FOR PHYSICAL ll-lERAPISTS
Table Vl-3. Continued
Propoxyphene (Darvon, Dolene, Doloxene, Novo-Propoxyn)
Remifentanil (Ultiva)
Sufentanil citrate (Sufenta)
Tramadol hydrochloride (Ultram, Zamadol, Zydol)
Sources: Data from JC Ballantyne, D Borsook. Postoperative Pain. In D Borsook, AA
LeBel, B McPeek (eds), The Massachusetts General Hospital Handbook of Pain Man·
agemcnt. BoSton: Little, Brown, 1996;249; and HL Fields (ed). Pain. New York:
McGmw·Hill, 1987;253; Nursing 2001 Drug Handbook (21st cd). Springhouse, PA:
Springhouse Corporation, 200 t ;368-392; and L Skidmore-Roth (cd). Mosby's Nursing
Drug Reference. 51. Louis: Mosby, 2001;58-59.
Table VI-4. Epidural Catheters
Indications:
Surgeries of the thorax or upper and lower abdomen, especiall)' in patients
with significant pulmonary disease
Surgery of the lower extremity, especially when early mobilization is important
Vascular procedures of the lower extremi[)', when sympathetic blocks are used
Mechanism of action:
Prevent transmission of pain signals to the cerebrum at the spinal level with :1
catheter that is placed in the epidural space.
A mixture of opioids and local anesthetics is often used. This drug combination provides a synergistic effect for pain relief with a decreased incidence of side effects.
If patients do experience adverse side effects, nonsteroidal anti-inflammatory
drugs can be added to the mixture, and the dosages of the opioids or local
anesthetics are reduced.
General side effects:
Epidural opioids
Pruritus (itching), nausea, sedation and respiratory depression, decreased
gastrointestinal motility
Local anesthetics
Hypotension, temporary lower-extremity weakness, urine retention,
local anesthetic toxicity (ringing in the ears, metallic taste, slow
speech, irritability, cardiac arrhythmias, and seizures)
Medications: Generic (trade name)
Epidural opioids
Morphine, fentanyl, sufentanil, alfentanil, hydromorphone (Dilaudid),
and meperidine (Demcrol)