In this section : General Surgery
Analgesia
Acute Appendicitis
Small Bowel Obstruction
Gallstone Disease
Laxatives
Surgical Post-operative Complications
Stoma
Diverticular Disease
Home | Articles | General Surgery |
Analgesia
Last updated 14th May 2021
- Prescribe paracetamol regularly 1g QDS (if <50kg or severely deranged LFT – 500mg QDS)
- NSAIDs – avoid if AKI/CKD, background of gastritis, high risk of haemorrhage, severe asthma, vascular/ heart disease
- Co-codamol 30/500 (2 tablets) QDS – ensure paracetamol is not prescribed concurrently
- Morphine
- Prescribe 5-10mg oral (Oramorph) unless opioid naive/ elderly/ low weight
- Can cause constipation – prescribe with PRN laxatives
- Avoid in renal failure as excreted renally
- Some patients may require IV Morphine – titrate this based on symptoms
- Often the FY1 would need to administer IV Morphine
- 1-2mg per 1-2 minutes, administer until patient starts seeing improvement in symptoms (max 10mg at one time)
- Oxycodone (Oxynorm)
- 5mg of oxycodone = 10mg of morphine
- First line in patients with CKD
- PCA – patient controlled analgesia
- This is often prescribed for patients post-op as it allows patients to gets regular & adequate pain relief
- Also prescribed when regular opioid analgesia doesn’t help with pain relief
- Prescribed on HEPMA – PCA
DRUG | CONCENTRATION | BOLUS DOSE | CONTINUOUS RATE | |
---|---|---|---|---|
A MORPHINE | Morphine | 2 mg/ml | 1 mg | 0 mg/hr |
B MORPHINE | Morphine | 2 mg/ml | 2 mg | 0 mg/hr |
E FENTANYL | Fentanyl | 20 micrograms/ml | 10 micrograms | 0 micrograms/hr |
F MORPHINE CONTINUOUS | Morphine | 2 mg/ml | 1 mg | 1 mg/hr |
G MORPHINE CONTINUOUS | Morphine | 2 mg/ml | 1 mg | 2 mg/hr |
J FENTANYL CONTINUOUS | Fentanyl | 20 micrograms/ml | 10 micrograms | 10 micrograms/hr |
MODIFIED MORPHINE | Morphine | Up to prescriber | ||
MODIFIED FENTANYL | Fentanyl | Up to prescriber - usually 20 micrograms |
- Neuropathic pain
- 1st line – Amitriptyline or Gabapentin
- 2nd line – Pregabalin
- Diabetic neuropathic pain – Duloxetine
- Topical analgesia
- NSAID gel – ibuprofen, diclofenac
- Patches – Lidocaine, Fentanyl
- Whom to phone?
- Acute pain team would be first point of contact
- Libby Jardine – Ext 32020
- Leigh Fitzpatrick – Ext 32210
Link to Acute Pain diagram (NHS DG computers only)