The Role of Anesthesiologist in Pain Manajement

Husni Tanra

Department ofAnesthesiology, IC and Pain Management

Faculty of Medicine Hasanuddin UniversityMakassar

Anesthesia was the first

applied science in the world

Before Eva was created from

Adam’s rib, he was put into sleep

Prof. HyodoJapan

First Ether Anesthesia in 1846 at Massachusetts HospitalWilliam T, Morton (left) holding globe inhalerJohn C Warren the SurgeonGilber Abbot the Patient

The feat earned Morton the epitaph in Massachusetts

• The Inventor of anesthetic inhalation

• By whom pain in surgery was annulled

• Since whom science has control of PAIN• Before whom, surgery as agony

What is Anesthesiology?

Anesthesiology is the practice of medicine dedicated to the pain relief and total care of the surgical patient before, during and after surgery.

Who is Anesthesiologist?

Anesthesiologists is a physician who focus on surgical patient and pain relief.

( perioperative pain management doctor)

Two main role of anesthesiologistsare:

1. Life Saving

(we r master in CPR)

2. Alleviate suffering

(pain relief)

The main role of Anesthesiologist

History of Pain Managementand Critical Care Medicine

First Anesthesiologist who practice pain management in US. Founder the Society for Pain Practice Management (SPPM). One of the leader of Intervention Pain Management.

Steven D. WALDMAN

ANESTHESIOLOGIST is a superman DoctorIS NOT JUST IN THE OPERATING ROOM

• Operating roomhospital

surgicenter

• Labor & delivery suite

• Other procedural areas

• Intensive care unit (ICU)

• PACU

• Pain management

acute pain

chronic/ cancer pain

o Emergency Medicine

• “Code Blue” team

• Respiratory therapy

• Administration

operating room

hospital

medical school

• Education

health professionals

public

• Research

• ManagersCopyright © 2003 American Society of Anesthesiologists. All rights reserved

The Ideal Anesthesiologist

Who is Anesthesiologist?

• Anesthesiologist Is a suprman phycisian, not only in OR but also ........

• Anesthesiology, best job in America.

• Their salary of;

Anesthesiologist earn $ 292.000/year

Obgy doctor $ 222.000/year

Psychiatrist $ 177.000/year

GREAT Z’S 2009

Why it has to be an anesthesiologist in Pain Clinic?

• We are working with various analgesic drugs in our daily basis;

1. Common analgesic (paracetamol)

2. Non-opioid analgesic (NSAIDs)

3. Opioid analgesic

4. Local anesthetic

5. We had been trained in regional blocks, cenrally or peripherally. So we are mastering in pain pathway.

Why Anesthesiologist for PM?

• Our experiences in OT, made us to get use in peripheral as well as neuroaxial block

This is the Basic interventionpain management

Peripheral Neural blockade

Neuraxial Blockade

Epidural BlockMultipurpose weapon for;

• Epidural Anesthesia

• Post operative pain relief

• Treatment of chronic pain (LBP, symphaticpain, etc).

• Cancer pain, if oral or iv is failed.

Acute pain (Management of post operative pain at APS):

Epidural for Postoperative Pain management.

Caudal Block in Pediatric

Caudal Block in Pediatric

Before Caudal Block

After Caudal Block

Caudal Block in Adult

Epiduroscopy( Minor Surgery)

EpiduroscopyMinor Surgery

Epiduroscopy(Minor Surgery)

STELLATE GANGLION BLOCK

at pain - clinic

Chronic pain in Pain clinic

Stellate Ganglion Block

Indication of SGB:

1. Reflex SymphaticDystrophy (RSD)

2. Phantom Limb Pain

3. Herpes Zooster

4. Raynaud’s Syndrome

5. Facial Palsy

Epidural steroid for radicular painAt pain-clinic

Chronic Pain

Femoral Block for Post Herpetic neuralgiadone in pain-clinic

Femoral Block for Post Herpetic neuralgia.

done in pain-clinic

Anesthesiology residents learn pain management in Onomichi Hospital, Japan

Historyry of Intervention Pain Management?

Interventional pain management have been developing new technique since 1960 by John Bonica.

This tehnique was previously the role of Anesthesiologists, but now is opened to many other spesialists ( neurosurgeons, orthopaedics, rehabilitation medicine, and so on).

American Society of Interventional Pain Physicians (ASIPP),

Imaging techniques have become a part of this new techniques.

KepMenkes 779/Menkes/Sk/VIII/2008 ttgstandar pelayanan anestesiologi dan

reanimasi di rumah sakit

Why it has to be an anesthesiologist in Pain Clinic?

• We are working with various analgesic drugs in our daily basis;

1. Has been trained at least 4 years in

2. using Analgesic Opioid, Non- opiod as well as Adjuvan drugs, inlude Local anesthetics.

3. We had been trained in regional blocks, cenrally or peripherally. So we are mastering in pain pathway.

4. We are mastering in CPR, cause this is our daily activity In Operating teatre

54

We Anesthesiologists are diserve to

work in pain clinic, because pain

management is a part of our

competence.

Husni Tanra

In conclution, I want to say that;

55

If we don’t want to do it,

somebody else will

Eddy Rahardjo

• Be a good Anesthesiologist

Not only providing good and safe anesthesia in OT, but alsoProviding pain management

jangan mau disebut sebagaiDokter Bius (Bihos)

Thank you very much

For your attention

Memory picture with Prof. John Bonica in Seattle, US. January 1988

Makassar 23 Oktober 2013.

atas perhatian dan pengertiaannya.