Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Pain management and postoperative careIf the patient requires analgesia for further advice contact the PainTeam on bleep 2492 or 2493 or ward pharmacist.Discharge medicationMethadone or buprenorphine will not be supplied at discharge.Exceptions to this will be on the instruction of the CDT only and amaximum of 24 to 48 hours supply can be provided.The CDT should be contacted by the medical or nursing team toensure that the community supply and follow-up is resumed atdischarge.If the CDT is unavailable then contact the hospital pharmacydepartment for further advice.Guidelines for the management of opiate withdrawal symptoms inhospital patients who are opiate usersWithdrawal syndromes differ according to the particular drugsinvolved, the daily amounts taken, the duration of use and individualsensitivity. Withdrawal from opiates is associated with a specificwithdrawal syndrome. Assessment of withdrawal should be based onobservable signs rather than subjective symptom reporting. Theseverity and management of withdrawal is greatly influenced bypatient anxiety so informing patients about how their symptoms arelikely to vary over time can help to reduce this.The following treatments are recommended dependent upon thesigns and symptoms.Signs and symptomsNausea and vomitingDiarrhoeaStomach crampsTreatmentProchlorperazine orally 5mg 8-hourly or12.5 mg IM 8-hourly or cyclizine orally50 mg 8-hourlyOral loperamide 4 mg stat followed by2 mg after each loose stool for up to 5days. Max 16 mg daily dose.Mebeverine 135 mg tds (oral).120 Anaesthetists Handbook January 2010