Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Fractured neck of femurPostoperative analgesia after fractured neck offemur[Dr John Elton, February 2006; revised, January 2010]This guideline has been revised following a clinical audit project. Theresults were that these patients received prescriptions that variedwidely and were not based on sound principles. The aim of thisagreed analgesia guideline is to ensure that each patient suffers nomore than mild postoperative pain, is able to cooperate withphysiotherapy, and has minimal side effects from the medication.Intraoperative analgesia• A form of lumbar plexus block (anterior or posterior).• Intravenous paracetamol 1 g (if not already commenced).• Opiate analgesia as required.Regular postoperative analgesia• Paracetamol 1 g oral or intravenous q.d.s.• Codeine phosphate 30 mg oral or i.m. q.d.s.: eight doses• Lactulose 20 mg oral b.d.• Oxygen 2 L min -1 by nasal cannulae for 48 hours.As required analgesia• Oramorph 10 mg every two hours.• Buccal prochlorperazine (Buccastem) 6 mg b.d.AVOID• Morphine by injection and cyclizine.154 Anaesthetists Handbook January 2010