nhs forth valley formulary 11 - Community Pharmacy

Forth Valley Formulary Eleventh Edition 2012/13Appendix 9Acute Pain Service Guidelines for inpatient acute painAcute Pain StepladderSEVERE PAINMorphine sulphate solution (10mg/5ml) 10mg PRN orRegional analgesia e.g. epidural analgesia orMorphine PCA or s/c protocolhttp://www.qifv.scot.nhs.uk/CE_Guidance.asp?topic=Pain%20Managementplus NSAID (if tolerated)plus paracetamol 1g QDS regularlyMODERATE PAINDihydrocodeine 30-60mg 4 hourly (max 240mg daily)plus NSAID (if tolerated)plus paracetamol 1g 6hrly regularlyMILD PAINparacetamol 1g 6hourlyplus NSAID (if tolerated)• It is advisable not to give dihydrocodeine or tramadol with other opiate based products.• NSAID = Ibuprofen 400mg TID (second line = Diclofenac 50mg TID)• NSAID’s should not be prescribed for more than one week in the first instance.• Do not prescribe NSAID’s in the presence or renal impairment, dehydration or ahistory of peptic ulceration.• Pregnancy/breast feeding – refer to BNF• All analgesia MUST be reassessed prior to discharge.APS is available for advice on page 100 during normal working hoursSr Baggott / Dr E JackPharmacist Lead:Peter BucknerPage 69