Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Pain management and postoperative careModerate to severe pain options• Paracetamol 1000 mg qds. AND oral morphine 10 mg qds. (with10 mg oral morphine p.r.n. between regular doses).• Paracetamol 1000 mg qds. AND dihydrocodeine 30-60 mg qds.• Paracetamol 1000 mg qds. AND codeine 30-60 mg qds.In addition, consider NSAIDs if appropriate.Mild to moderate pain options• Regular or p.r.n. co-dydramol (paracetamol 500 mg withdihydrocodeine 10 mg), two tablets up to four times a day.• Regular or p.r.n. co-codamol 8/500, two tablets up to four timesa day.• Regular or p.r.n. paracetamol 1000 mg up to four times a day.In addition, consider NSAIDs if appropriate.Do not forgetLaxatives – lactulose with or without senna to prevent and treatopioid-induced constipation.Anti-emetics – to prevent and treat opioid-induced nausea andvomiting.Ketamine infusions for acute pain[Acute pain team, November 2008]Ketamine is an NMDA receptor antagonist which has been used asan anaesthetic agent for many years. Ketamine acts at a number ofreceptors including NMDA and opioid receptors. It can provideexcellent analgesia at small sub-anaesthetic doses and is opioidsparing,reducing sedation and other opiate side effects, and leadingto a faster return of bowel function after gastrointestinal surgery .Uses• Treatment of acute pain98 Anaesthetists Handbook January 2010