Analgesia Anaesthesia section



Assessment

  • Pain Score in isolation is NOT useful.
  • Need also to consider findings of catecholamine surge:
    • Raised BP, HR, RR, Sweating, Flushed, Nausea.
  • Distress is distress, perhaps (not always) secondary to pain.
  • Treat distress with appropriate small doses of anxiolytics and you will lower your analgesic requirement.
  • BUT… anxiolytics themselves are NOT a treatment for pain!
  • Different types of pain required different approaches:
    • Try to working out where the pain is coming from.

stablish an Analgesia Base

  • Paracetamol and NSAID (if not contraindicated) for all

Manage the Source of pain

Nociceptive Pain (i.e. Normal pain associated with acute injury/insult)

  • Epigastric Pain: PPI or H2 Receptor Antagonist (i.e. Zoton Fastab MADE IN IRELAND)
  • Cramping Pain: Hyoscine Butylbromide (Buscopam)
  • Is the patient constipated? (Movicol, Microlette, etc.)
  • Inflammatory Pain: (NSAIDs, or Steroids) ± Antihistamine
  • Bone / Muscle Pain: i.e. acute injury – see separate section
  • Nausea and Vomiting/ Retching Pain: NG tube ± Anti emetics

Neuropathic Pain (i.e. Chronic, abnormal processing of sensory input)

  • For chronic, please see Neuropathic Pain page
  • Assessment is important: Is this new pain because the patient is constipated? Gastritis? Injured?
  • Antidepressant and Anti-epileptics have role (has the patient recently stopped them?)
  • Is the patient still taking their Paracetamol + NSAID (i.e. baseline).
  • Better for the patient to be given Breakthrough pain relief and to see Pain Team in elective setting for objectivity.

When to reach for Strong Opiates (Morphine preparations)

  • In Acute Visceral Pain
  • ONLY once all of the above options have been utilised
  • Titrate to response

In Neuropathic Pain


Managing Injuries in the ED

  1. Decide how you are going to TREAT the pain!
    1. Reduce, Splint, Cover or Irrigate?
  2. Analgesia Base
    1. Paracetamol + NSAID +- Simple opioid (codeine NOT Morphine).
    2. Procedural Analgesia and Sedation
      - See separate Sedation Policies for Adults and Children
      - Short acting opiates such as Fentanyl for the procedure itself ±
      - Short acting Hypnotic (e.g. See policy) or
    3. Regional Anaesthetic technique.
  3. Treat the pain
    1. Dislocations: Reduce.
    2. Fractures: Splint
    3. Burns: Cover from air.
    4. Irritant: Irrigate.
  4. Post Treatment Options:
    1. Maintain Analgesia Base.
    2. Consider Codeine/Paracetamol preparations (Solpadine 8/500 or Solpadol 30/500).
    3. Splinting/Strapping/Immobilise.
    4. Going to theatre/in-patient: Consider Long acting Opiate (Morphine).

Content by Dr Jason Van Der Veldt 03/11/2010. Last review Dr Íomhar O' Sullivan 5/05/15