- Use the oral route whenever possible.
- Give paracetamol and NSAIDS regularly and opioids as needed.
- Review analgesia regularly, at least once a day.
- When changing from one route of administration to another, remember to use equipotent (equal strength) doses.
- A multi-modal approach improves pain relief, reduces the patient’s opioid requirements and hence opioid side effects.
- Do not prescribe compound analgesics. i.e co-codamol.
Adult oral analgesia
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Please refer to NSAID guidelines.
Please remember the side-effects of NSAIDs and stop them if the patient develops dyspepsia or renal impairment.
- In the elderly use a reduced dose and longer dosing interval.
- Patients with moderate to severe renal impairment (see acute pain management in adults with renal impairment) or liver impairment may need a reduced dose and a longer dosing interval.
Remember unexpected pain must be investigated for other causes, especially if the analgesia prescribed becomes ineffective. The patient's condition can change.
Combination of opioids should not be prescribed or given.
- If you need to change opioids seek advice from Acute Pain Team and/or see Opioid Conversion Chart in the BNF or Palliative Care Formulary.
The most common side effects of opioids are:
Laxatives may need to be prescribed. Use with caution if patient has had bowel surgery. Encourage a high fibre diet and adequate fluid intake. Assess for other causes. Older adult inpatient management of constipation.
Nausea and vomiting:
An anti-emetic should be prescribed and administered. See PONV guidelines.
Assess cause – may not be opioid. Ondansetron can help or low dose naloxone.
If respiratory rate is less than 7 per minute and/or sedation score is 3:
- Contact medical staff, clinical nurse practitioner or the Acute Pain Nurse.
- Administer 10litres/min of oxygen via Hudson face mask.
- Give naloxone (see naloxone guidance)
CAUTION WITH THE FOLLOWING PATIENTS
Use a reduced dose with a longer dosing interval in the elderly.
Refer to the acute pain management in adults with renal impairment
Contact acute pain team for advice on patients with severe liver impairment.
At Raigmore Hospital the Acute Pain Team includes:
Consultant Anaesthetist - Department of Anaesthesia
Advice can be sought in office hours - 08.00 – 16.00 (page 1003 or 6056)
|eGFR||Estimated glomerular filtration rate|
|AKI||Acute kidney injury|
|ACE inhibitors||Angiotensin-converting-enzyme inhibitors|