Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issuesAnalgesia Fentanyl 2 µg kg -1 intravenously at induction +paracetamol 1 g intravenously (if not given aspremed) intraoperatively.Morphine 0.2 mg kg -1 titrated to response intraoperativelyif required.Ketorolac 30 mg during closure (if not contraindicatedand in the absence of excess oozing fromliver bed).AntiemeticsIntravenousfluidsLocalanaesthesiaRecoveryCyclizine 50 mg (intramuscular at induction or slowintravenous) + ondansetron 8 mg + dexamethasone8 mg.Hartmann’s solution (15 mL kg -1 – 1000 mL in theaverage adult).Ensure that the surgeon uses local anaestheticinfiltration.Levobupivacaine 0.5% to a maximum dose of2 mL.kg -1 should be used. The quality of pain reliefis the same if the port sites are infiltrated before orafter the incision.Morphine 2 mg intravenous as needed every fiveminutes to a maximum of 10 mg (for pain score 2 orgreater).The dose of morphine should be carefully titrated soas to provide adequate analgesia while minimisingside effects such as nausea, respiratory depressionand sedation.Systemic opioids should generally not be requiredbeyond the first few hours of recovery; oralanalgesics will then usually be sufficient.Anaesthetists Handbook January 2010 207