Protocols - Hemorio

ANALGESIA DEGREES: Analgesia, with the usage of opioid and non steroidal anti-inflammatory, is
frequently necessary for pains of the somatic and visceral type. The neuropathic or deafferentation pain
responds improperly to the usage of opioid, presenting a better response to the tricyclic antidepressant.
The WHO proposes the usage of analgesic through a ladder of three steps:
1 st NON- OPIOIC ANALGESIC (ANES) + ADJUVANTS
2 nd WEAK OPIOID + NON-OPIOID ANALGESIC
3 rd STRONG OPIOID + NON-OPIOID ANALGESIC
TYPES OF ANALGESIC:
NON OPIOID Dipirona / Acetaminophen / AAS / Paracetamol
NON STEROIDAL
ANTI-
INFLAMMATORY
AAS / Diclofenac / Indomethacin / Ibuprofen
WEAK OPIOID Codeine / Tramadol Hydrochloride / Propoxyphene
STRONG OPIOID Morphine / Fentanyl / Pethidine / Buprenorphine / Nalbufine / Methadone /
Oxycodone / Sufentanil / Alfentanil / Remifentanil
ADJUVANTS Anticonvulsant / Antidepressant / Neuroleptic / Benzodiazepine / Anticholinergic
3 - ANALGESIC, ANTI-INFLAMMATORY AND ANTIPYRETIC:
Consider that the anti-inflammatory dosage is already the maximum analgesic dosage. Therefore, the
increase of the dose of such drugs or the association of another drug of the same group would only result
on an increment of the adverse effects, not providing any satisfactory analgesia. Consequently, if there is
no satisfactory analgesia, we must pass to the second degree of the analgesic ladder. In this group, only
paracetamol, at the usual doses, is not an anti-inflammatory.
INDICATIONS:
In every type of acute pain and in every type of pain that presents an inflammatory component with
release of inflammatory substances (all acute pains and some chronic pains).
At the primarily inflammatory nature pains, with a mild to moderate intensity as the first agent, it must be
used parenterally at the intense pain.
At the mild to moderate pains, use non steroidal anti-inflammatory (AINES) with a short half-life: aspirin,
ketoprofen and paracetamol.
At the osteo-articular, subacute pains, which may last for a period of about 10 days, we may prescribe
derivatives with a long action; however they just reach a stable plasmatic concentration in approximately 4
days.
HOW TO PRESCRIBE:
Always use a regular regimen, observing the half-life of the drugs.
Associate the opiace whenever it has reached the maximum dosage, without obtaining a satisfactory
analgesia.
Use preferably the oral path, the parenteral path is indicated when you want to reach plasma
concentrations fastly (e.g., post-operatory) and when the subject is incapable to deglute.
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