Maximising the benefits of TIVA

Preventive Analgesia

• Practice aimed at lowering short- and long-term post-surgery pain
• Reduces central pain sensitisation
• Interruption of pain signal transmission to the central nervous system
• Attenuates noxious stimulus
• Limits effects of tissue injury and inflammation

Multimodal analgesia is employed to target different receptors at many points along the pain pathway. An effective regimen decreases postoperative pain, opioid consumption and overall side effects from any individual drug. This is of huge importance as unwanted side-effects negate the benefits seen with the use of TIVA.

ABC of Calculating the analgesia requirement

• Anticipated
  • Surgery: intra- and postoperative requirement
  • Laproscopic: high intraoperative lower postoperative requirement
  • Open: high intra- and postoperative requirement
• Baseline
  • Acute pain
  • Chronic pain
  • Regualr analgesia, sedatives or psychiatric medication
• Comorbidities
  • Cardiovascular
  • Respiratory
  • CNS
  • Hepatic
  • Renal

Patient comorbidites may alter the pharmacokinetics and dynamics of the drugs. The past medical history of your patient will limit and guide your perioperative choices.

For the remainder of this article, we will focus on the drug categories not previously covered.