Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Pain management and postoperative careMaximum 4 hourly dose20 mLThe keypad on the pump will be locked to prevent tampering. Thepump may be stopped and the history may be checked withoutunlocking the keypad. The HDU nurse, on-call anaesthetist and painteam will be able to unlock the keypad if required.Prescriptions1. Naloxone 4 µg kg -1 as a stat dose IV PRN. This dose is toreverse sedation, whilst maintaining analgesia and may berepeated.2. Antiemetic – ondansetron 0.1 mg kg -1 (maximum dose 4 mg.) IV.Prescribe 8-hourly as needed for 48 hours.3. Regular analgesia – paracetamol ± NSAID.ComplicationsBoth the surgical and the anaesthetic teams will be called. Thenurses will give naloxone 4 µg kg -1 to an over-sedated child ifprescribed.Constipation, paralytic ileus, urinary retention, itching and musclespasms can occur.Antihistamines may be used for itching. Diazepam may be prescribedin small doses for muscle spasm in orthopaedic patients.Trust guideline on the care of patients who havereceived intrathecal morphine or diamorphineThis guideline was last reviewed in 2009. Essential points are listedbelow.Morphine and diamorphine will give prolonged analgesia aftersurgery but carry certain risks. Trainees who are not familiar withthese techniques using morphine and diamorphine must not usethem except under direct supervision.110 Anaesthetists Handbook January 2010