Page 13 Acute Pain Management

5.3 Adjuvant Drugs ........................................................................................................ 131
5.3.1 Alpha‐2 agonists................................................................................................131
5.3.2 Adrenaline.........................................................................................................132
5.3.3 Ketamine ...........................................................................................................133
5.3.4 Midazolam.........................................................................................................134
5.3.5 Neostigmine ......................................................................................................134
5.3.6 Magnesium........................................................................................................135
5.3.7 Botulinum toxin A..............................................................................................135
5.4 Anti‐inflammatory drugs.......................................................................................... 136 CONTENTS
5.4.1 Corticosteroids ..................................................................................................136
5.4.2 Non‐steroidal anti‐inflammatory drugs.............................................................137
References ....................................................................................................................... 138
6. ADMINISTRATION OF SYSTEMIC ANALGESIC DRUGS................................................. 150
6.1 Oral route ................................................................................................................ 150
6.1.1 Opioids and tramadol........................................................................................153
6.1.2 Non‐selective non‐steroidal anti‐inflammatory drugs and coxibs ....................154
6.1.3 Paracetamol ......................................................................................................155
6.2 Intravenous route .................................................................................................... 155
6.2.1 Opioids and tramadol........................................................................................155
6.2.2 Non‐selective non‐steroidal anti‐inflammatory drugs and coxibs ....................156
6.2.3 Paracetamol ......................................................................................................156
6.3 Intramuscular and subcutaneous routes................................................................... 157
6.3.1 Opioids and tramadol........................................................................................157
6.3.2 Non‐selective non‐steroidal anti‐inflammatory drugs and coxibs ....................158
6.4 Rectal route ............................................................................................................. 158
6.4.1 Opioids ..............................................................................................................158
6.4.2 Non‐selective non‐steroidal anti‐inflammatory drugs ......................................158
6.4.3 Paracetamol ......................................................................................................159
6.5 Transdermal route ................................................................................................... 159
6.5.1 Opioids ..............................................................................................................159
6.5.2 Other drugs .......................................................................................................160
6.6 Transmucosal routes ................................................................................................ 160
6.6.1 Intranasal route.................................................................................................160
6.6.2 Sublingual and buccal routes.............................................................................162
6.6.3 Inhaled...............................................................................................................163
References ....................................................................................................................... 164

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