Acute Pain Management

Mild pain

• Paracetamol 1g QDS (reduce to TDS if renal/hepatic impairment, < 40kg, or malnourished)

• Ibuprofen 400mg TDS

• Naproxen 250-500mg TDS

Moderate pain

• ADD on a weak opioid e.g. Codeine, Co-codamol, Dihydrocodeine, Tramadol

Severe pain

• CHANGE weak opioid to strong opioid e.g. Morphine, Diamorphine, Oxycodone, Fentanyl

  • N.B. For adults in acute pain, initial doses are 10mg PO/SC/IM or 5mg IV

  • N.B. Opioid analgesics should be avoided in those with respiratory disease

    
    

Post-Operative Options

Epidural or Spinal anaesthesia - There are multiple pros and cons of each, so the choice depends on the patient and preference. Epidural anaesthesia doesn’t produce as high of an effect, and it takes longer to work (25-30 mins), but it can be adjusted and titrated to the patient's needs, and lasts a lot longer. Spinal anaesthesia produces a stronger effect and works quicker (5 mins), but it doesn’t last as long (few hours).

N.B. A complication of spinal anaesthesia is a Low pressure headache, in which the patient develops a severe headache within the next 24 hours.