Page 12 Acute Pain Management

3. PROVISION OF SAFE AND EFFECTIVE ACUTE PAIN MANAGEMENT .............................. 45
3.1 Education................................................................................................................... 45
3.1.1 Patients ...............................................................................................................45
3.1.2 Staff .....................................................................................................................46
3.2 Organisational requirements...................................................................................... 47
3.2.1 General requirements .........................................................................................48
CONTENTS References ......................................................................................................................... 50
3.2.2
Acute pain services..............................................................................................48

4. SYSTEMICALLY ADMINISTERED ANALGESIC DRUGS..................................................... 55
4.1 Opioids ...................................................................................................................... 55
4.1.1 Choice of opioid...................................................................................................55
4.1.2 Specific opioids....................................................................................................55
4.1.3 Determinants of opioid dose...............................................................................61
4.1.4 Adverse effects of opioids...................................................................................62
4.2 Paracetamol, non‐selective non‐steroidal anti‐inflammatory drugs and coxibs .......... 71
4.2.1 Paracetamol ........................................................................................................71
4.2.2 Non‐selective non‐steroidal anti‐inflammatory drugs ........................................73
4.2.3 Cyclo‐oxygenase‐2 selective inhibitors (coxibs) ..................................................75
4.3 Adjuvant drugs........................................................................................................... 79
4.3.1 Inhalational agents..............................................................................................79
4.3.2 NMDA‐receptor antagonists ...............................................................................83
4.3.3 Antidepressant drugs ..........................................................................................87
4.3.4 Anticonvulsant drugs...........................................................................................89
4.3.5 Membrane stabilisers..........................................................................................91
4.3.6 Alpha‐2 agonists..................................................................................................92
4.3.7 Salmon calcitonin and bisphosphonates.............................................................92
4.3.8 Cannabinoids.......................................................................................................93
4.3.9 Glucocorticoids....................................................................................................94
4.3.10 Complementary and alternative medicines ........................................................96
References ......................................................................................................................... 97
5. REGIONALLY AND LOCALLY ADMINISTERED ANALGESIC DRUGS................................ 121
5.1 Local anaesthetics.................................................................................................... 121
5.1.1 Short‐duration local anaesthetics .....................................................................121
5.1.2 Long‐duration local anaesthetics ......................................................................121
5.1.3 Local anaesthetic toxicity ..................................................................................124
5.2 Opioids .................................................................................................................... 126
5.2.1 Neuraxial opioids...............................................................................................126
5.2.2 Peripheral opioids .............................................................................................129

xii Acute Pain Management: Scientific Evidence