Page 22 Acute Pain Management
P. 22
14. The incidence of clinically meaningful adverse effects of opioids is dose‐related (U)
(Level II).
15. High doses of methadone can lead to prolonged QT interval (N) (Level II).
16. Haloperidol is effective in the prevention of postoperative nausea and vomiting (N)
(Level II).
17. Opioid antagonists are effective treatments for opioid‐induced urinary retention (N)
(Level II).
18. In clinically relevant doses, there is a ceiling effect for respiratory depression with
SUMMARY 19. Assessment of sedation is a more reliable way of detecting early opioid‐induced
buprenorphine but not for analgesia (N) (Level III‐2).
respiratory depression than a decreased respiratory rate (S) (Level III‐3).
20. The evidence for risk of cardiac arrhythmias following low‐dose droperidol is poor (N)
(Level III‐3).
21. In adults, patient age rather than weight is a better predictor of opioid requirements,
although there is a large interpatient variation (U) (Level IV).
22. Impaired renal function and the oral route of administration result in higher levels of the
morphine metabolites morphine‐3‐glucuronide and morphine‐6‐glucuronide with
increased risk of sedation and respiratory depression (S) (Level IV).
The use of pethidine (U) and dextropropoxyphene (N) should be discouraged in favour of
other opioids.
Paracetamol, non‐selective non‐steroidal anti‐inflammatory drugs and coxibs
1. Paracetamol is an effective analgesic for acute pain; the incidence of adverse effects
comparable to placebo (S) (Level I [Cochrane Review]).
2. Non‐selective NSAIDs are effective in the treatment of acute postoperative and low back
pain, renal colic and primary dysmenorrhoea (N) (Level I [Cochrane Review]).
3. Coxibs are effective in the treatment of acute postoperative pain (N) (Level I [Cochrane
Review]).
4. With careful patient selection and monitoring, the incidence of nsNSAID‐induced
perioperative renal impairment is low (U) (Level I [Cochrane Review]).
5. Non‐selective NSAIDs do not increase the risk of reoperation for bleeding after
tonsillectomy in paediatric patients (Q) (Level I [Cochrane Review]).
6. Coxibs do not appear to produce bronchospasm in individuals known to have aspirin‐
exacerbated respiratory disease (U) (Level I).
7. In general, aspirin increases bleeding after tonsillectomy (N) (Level I).
8. Non‐selective NSAIDs given in addition to paracetamol improve analgesia compared with
paracetamol alone (U) (Level I).
9. Paracetamol given in addition to PCA opioids reduces opioid consumption but does not
result in a decrease in opioid‐related side effects (N) (Level I).
10. Non‐selective NSAIDs given in addition to PCA opioids reduce opioid consumption and
the incidence of nausea, vomiting and sedation (N) (Level I).
xxii Acute Pain Management: Scientific Evidence
