Page 17 Acute Pain Management

11. OTHER SPECIFIC PATIENT GROUPS............................................................................ 381
11.1 The pregnant patient ............................................................................................... 381
11.1.1 Management of acute pain during pregnancy..................................................381
11.1.2 Management of pain during delivery................................................................386
11.1.3 Pain management during lactation...................................................................390
11.1.4 Pain management in the puerperium ...............................................................394
11.2 The older patient ..................................................................................................... 396
11.2.1 Pharmacokinetic and pharmacodynamic changes............................................397
11.2.2 Physiology and perception of pain....................................................................398 CONTENTS
11.2.3 Assessment of pain............................................................................................400
11.2.4 Drugs used in the management of acute pain in older people .........................402
11.2.5 Patient‐controlled analgesia .............................................................................405
11.2.6 Epidural analgesia .............................................................................................405
11.2.7 Intrathecal opioid analgesia ..............................................................................406
11.2.8 Other regional analgesia ...................................................................................406
11.3 Aboriginal and Torres Strait Islander peoples ........................................................... 408
11.4 Different ethnic and cultural groups......................................................................... 409
11.5 The patient with obstructive sleep apnoea............................................................... 411
11.6 The patient with concurrent hepatic or renal disease............................................... 414
11.6.1 Patients with renal disease ...............................................................................414
11.6.2 Patients with hepatic disease............................................................................415
11.7 The opioid‐tolerant patient...................................................................................... 422
11.7.1 Definitions and clinical implications..................................................................422
11.7.2 Patient groups ...................................................................................................423
11.7.3 Management of acute pain ...............................................................................423
11.8 The patient with an addiction disorder..................................................................... 427
11.8.1 Management of acute pain in pregnant patients with an addiction disorder ..429
11.8.2 CNS depressant drugs .......................................................................................430
11.8.3 CNS stimulant drugs ..........................................................................................431
11.8.4 Drugs used in the treatment of addiction disorders .........................................431
11.8.5 Recovering patients...........................................................................................433
References ....................................................................................................................... 433
APPENDIX A ..................................................................................................................... 452
The working party, contributors and members of the multidisciplinary consultative
committee ....................................................................................................................... 452
APPENDIX B ..................................................................................................................... 462
Process report.................................................................................................................. 462
ABBREVIATIONS AND ACRONYMS.................................................................................... 473
INDEX............................................................................................................................... 478

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