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Problem-Based Learning (PBL): Anesthesia & Analgesia Medical Challenge

Problem Based Learning

Problem based learning (PBL) is a popular method of learning, currently used by most health professional courses in the UK.

The aim of PBL is for you to read through a complex and broad series of information, to identify areas of interest and areas you would like to explore further, in order to further your knowledge of specific topics, through self-directed learning. 

If you have a passion for Problem-Based Learning (PBL) and are intrigued by witnessing how doctors navigate critical decision-making moments, we invite you to enrol in our Free Virtual Work Experience programme!

Stress & Anxiety

John is a 35-year-old man who has been living with chronic lower back pain that radiates down his right leg following a herniated disc a couple of months back. He has been managing the pain with ibuprofen, although the pain has been gradually getting worse, and he has elected for discectomy surgery in the hope that this will relieve it. 

John’s wife recently gave birth, and she opted for an epidural to help with her pain. John wonders if he will get a similar injection as part of his surgery.

In the operating theatre, the anaesthetist puts John under general anaesthetic and uses suxamethonium as a paralysing agent to allow them to intubate him for the procedure. The operation goes well, and as part of his postoperative care, John is given some morphine to numb the pain. 

Problem Based Learning Challenge Questions:

  1. What is the difference between analgesia and anaesthesia? 
  2. What is the structure of the spinal column?
  3. What is meant by a herniated disk and how might it cause pain?
  4. Where does the spinal cord finish in the adult and what is below it? 
  5. At what point of the spine would you choose to deliver an epidural anaesthetic and why?
  6. What is the difference between paracetamol and ibuprofen?
  7. What class of drug is morphine and what are the advantages and disadvantages of this?
  8. What is the action of suxamethonium at the neuromuscular junction? 
  9. Challenge: In what other ways could a drug act in order to be used as a muscle relaxant?

For aspiring medical students just starting to delve into Problem-Based Learning scenarios, here are some guidance hints to help give you a starting point of where to research:

1. Analgesia vs. Anaesthesia:

– Explore the mechanisms and purposes of analgesia and anaesthesia.
– Research how these differ in terms of blocking pain perception and inducing a loss of sensation.

2. Structure of the Spinal Column:

– Investigate the anatomy of the spinal column, focusing on its different components and their functions.
– Examine the role of intervertebral discs and their susceptibility to herniation.

3. Herniated Disk and Pain:

– Understand the concept of a herniated disk and how it may lead to pain.
– Explore the anatomy of nerves and their interaction with a herniated disk.

4. Spinal Cord Termination and Epidural Anaesthetic:

– Identify the termination point of the spinal cord in adults.
– Research why and where an epidural anaesthetic is administered in relation to the spinal cord.

5. Paracetamol vs. Ibuprofen:

– Compare and contrast the mechanisms of action of paracetamol and ibuprofen.
– Explore their indications, contraindications, and potential side effects.

6. Morphine:

– Determine the drug class to which morphine belongs.
– Investigate the advantages and disadvantages of using morphine for pain management.

7. Suxamethonium at the Neuromuscular Junction:

– Understand how suxamethonium works at the neuromuscular junction.
– Explore its role in facilitating intubation during surgery.

8. Muscle Relaxants:

– Research alternative ways in which a drug can act to serve as a muscle relaxant.
– Understand the diverse mechanisms by which muscle relaxants achieve their effects.

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