Acute Pain - final version - Faculty of pain medicine - Australian and ...

SUMMARY
Cannabinoids
1.
 Current
evidence
does
not
support
the
use
of
cannabinoids
in
acute
pain
management
(S)
but
these
drugs
appear
to
be
mildly
effective
when
used
in
the
treatment
of
chronic
neuropathic
pain,
including
multiple
sclerosis‐related
pain
(N)
(Level
I).
Glucocorticoids
1.
 Dexamethasone,
compared
with
placebo,
reduces
postoperative
pain,
nausea
and
vomiting,
and
fatigue
(Level
II).
Complementary
and
alternative
medicines
There
is
some
evidence
that
some
complementary
and
alternative
medicines
may
be
effective
in
some
acute
pain
states.
Adverse
effects
and
interactions
with
medications
have
been
described
with
complementary
and
alternative
medicines
and
must
be
considered
before
their
use
(N).
5. REGIONALLY AND LOCALLY ADMINISTERED ANALGESIC DRUGS
Local
anaesthetics
1.
 Lignocaine
is
more
likely
to
cause
transient
neurologic
symptoms
than
bupivacaine,
prilocaine
and
procaine
(N)
(Level
I
[Cochrane
Review]).
2.
 The
quality
of
epidural
analgesia
with
local
anaesthetics
is
improved
with
the
addition
of
opioids
(U)
(Level
1).
3.
 Ultrasound
guidance
reduces
the
risk
of
vascular
puncture
during
the
performance
of
regional
blockade
(N)
(Level
I).
4.

 Continuous
perineural
infusions
of
lignocaine
(lidocaine)
result
in
less
effective
analgesia
and
more
motor
block
than
long‐acting
local
anaesthetic
agents
(U)
(Level
II).
5.
 There
are
no
consistent
differences
between
ropivacaine,
levobupivacaine
and
bupivacaine
when
given
in
low
doses
for
regional
analgesia
(epidural
and
peripheral
nerve
blockade)
in
terms
of
quality
of
analgesia
or
motor
blockade
(U)
(Level
II).
6.
 Cardiovascular
and
central
nervous
system
toxicity
of
the
stereospecific
isomers
ropivacaine
and
levobupivacaine
is
less
severe
than
with
racemic
bupivacaine
(U)
(Level
II).
7.
 Lipid
emulsion
is
effective
in
resuscitation
of
circulatory
collapse
due
to
local
anaesthetic
toxicity,
however
uncertainties
relating
to
dosage,
efficacy
and
side
effects
still
remain
and
therefore
it
is
appropriate
to
administer
lipid
emulsion
once
advanced
cardiac
life
support
has
begun
and
convulsions
are
controlled
(N)
(Level
IV).
Opioids
Case
reports
following
accidental
overdose
with
ropivacaine
and
bupivacaine
suggest
that
resuscitation
is
likely
to
be
more
successful
with
ropivacaine
(U).
1.
 Intrathecal
morphine
produces
better
postoperative
analgesia
than
intrathecal
fentanyl
after
Caesarean
section
(U)
(Level
I).
2.
 Intrathecal
morphine
doses
of
300
mcg
or
more
increase
the
risk
of
respiratory
depression
(N)
(Level
I).
3.
 Morphine
injected
into
the
intra‐articular
space
following
knee
arthroscopy
does
not
improve
analgesia
compared
with
placebo
when
administered
after
surgery
(R)
(Level
I).
xxvi
Acute
Pain
Management:
Scientific
Evidence