Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Pain management and postoperative careOpioidsA significant number of patients are on high dose opioids (oral andtransdermal) for managing pain or for de-addiction programmes.1. Whenever possible, continue baseline opioid intake (oral andtransdermal) in the perioperative period.2. Additional analgesia will be required to cover acute surgical pain.3. Take measures to minimise additional opioid consumption byjudicious use of non-opioid medication and regional techniques.4. In most instances, there is no need to interrupt transdermalopioids (fentanyl, buprenorphine).5. In most instances, oral opioids can be continued uninterrupted inthe perioperative period (morphine, oxycodone, methadone).6. If oral intake is contraindicated for surgical reasons, convert toan alternate mode of opioid delivering (intravenous infusions inHDU and PACU; PCA and intramuscular injections in the wards)7. If planning intravenous infusion, calculate the total amount ofopioid taken from long acting (morphine sulphate, Oxycontin)and short acting (Oramorph, Oxynorm) forms over 24 hours.From this value calculate the hourly opioid consumption inmorphine equivalents. Start the basal infusion as 50% of thisamount. Intermittent boluses may be required and the dose canbe titrated against response.8. Alternatively, in the wards, choose a PCA strength (1 mg or2 mg bolus in five minutes) that meets the basal requirements toavoid opioid withdrawal.You should tailor individual analgesic requirement based on clinicalcircumstances, the nursing environment and the patient’s response totreatment.114 Anaesthetists Handbook January 2010