Acute Pain
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
The modalities of pain relief available are:
- Infiltration of the site with local anesthetic agents. The newer local anesthetic agent, bupivacaine gives total anesthesia for about 2.5 hours and some degree of analgesia for several hours.
- NSAIDs (nonsteroidal anti-inflammatory drugs) inhibit liberation of prostaglandins at the site of injury and thus decrease the sensitivity of nerve endings to all pain producing substances. Some commonly used drugs and the appropriate time interval for administration are:
- Ketorolac: 6 hourly
- Diclofenac: 8 to 12 hourly
- Ibuprofen : 6 to 8 hourly
- Piroxicam : 24 hourly
NSAIDs are reasonably safe if their relative contraindications are borne in mind. They are given below in decreasing order of importance.
- Acid peptic disease
- Bleeding disorders (they decrease platelet adhesion; but do not increase surgical hemorrhage in the normal patient)
- Renal failure
- Incipient cardiac failure (they can cause water retention)
- Bronchial asthma (in presence of which, sometimes bronchospasm may be precipitated). The following drugs are said to be relatively Cox2 selective, and may have less gastric, renal and platelet side effects.
- Tab Lexicon (Meloxicam) 15 mg daily
- Tab Articox (Rofecoxib) 25 mg daily
- Morphine 0.1-0.2 mg/kg
- Pethidine 1-2 mg/kg
- Tramadol (Tramadol) 1 mg/kg
Alternatives in Acute Pain
- Continuous epidural anesthesia with local an aesthetics or opioids or both.
- Continuous subcutaneous infusion with a syringe pump: patient-controlled analgesia (PCA).