Page 21 Acute Pain Management

4. While evidence for the benefit of patient education in terms of better pain relief is
inconsistent, structured preoperative education may be better than routine information,
and information presented in video format may be better still (N) (Level III‐2).
5. Implementation of an acute pain service may improve pain relief and reduce the
incidence of side effects (U) (Level III‐3).
6. Staff education and the use of guidelines improve pain assessment, pain relief and
prescribing practices (U) (Level III‐3).

7. Even ‘simple’ techniques of pain relief can be more effective if attention is given to
education, documentation, patient assessment and provision of appropriate guidelines
and policies (U) (Level III‐3).
 Successful management of acute pain requires close liaison with all personnel involved in SUMMARY
the care of the patient (U).
 More effective acute pain management will result from appropriate education and
organisational structures for the delivery of pain relief rather than the analgesic
techniques themselves (U).
4. SYSTEMICALLY ADMINISTERED ANALGESIC DRUGS

Opioids
1. Dextropropoxyphene has low analgesic efficacy (U) (Level I [Cochrane Review]).
2. Tramadol is an effective treatment for neuropathic pain (U) (Level I [Cochrane Review]).
3. Gabapentin, non‐steroidal NSAIDs and ketamine are opioid‐sparing medications and
reduce opioid‐related side effects (N) (Level I).
4. In appropriate doses, droperidol, metoclopramide, ondansetron, tropisetron, dolasetron,
dexamethasone, cyclizine and granisetron are effective in the prevention of
postoperative nausea and vomiting (N) (Level I [Cochrane Review]).
5. Alvimopan and methylnaltrexone are effective in reversing opioid‐induced slowing of
gastrointestinal transit time and constipation (N) (Level I [Cochrane Review]).
6. Droperidol, dexamethasone and ondansetron are equally effective in the prevention of
postoperative nausea and vomiting (U) (Level I).
7. Paired combinations of 5HT3 antagonist, droperidol or dexamethasone provide superior
prophylaxis of postoperative nausea and vomiting than either compound alone (N)
(Level I).

8. Naloxone, naltrexone, nalbuphine, droperidol and 5HT3 antagonists are effective
treatments for opioid‐induced pruritus (N) (Level I).
9. Opioids in high doses can induce hyperalgesia (N) (Level I).
10. Tramadol has a lower risk of respiratory depression and impairs gastrointestinal motor
function less than other opioids at equianalgesic doses (U) (Level II).
11. Pethidine is not superior to morphine in treatment of pain of renal or biliary colic (U)
(Level II).
12. Morphine‐6‐glucuronide is an effective analgesic (N) (Level II).

13. In the management of acute pain, one opioid is not superior over others but some
opioids are better in some patients (U) (Level II).

Acute pain management: scientific evidence xxi