Page 44 Acute Pain Management
P. 44






 Caudal
local
anaesthetic
blocks
provide
effective
analgesia
for
lower
abdominal,
perineal

and
lower
limb
surgery
and
have
a
low
incidence
of
serious
complications
(U).

 Continuous
epidural
infusions
provide
effective
postoperative
analgesia
in
children
of
all

ages
and
are
safe
if
appropriate
doses
and
equipment
are
used
by
experienced

practitioners,
with
adequate
monitoring
and
management
of
complications
(U).


Acute
pain
in
children
with
cancer

1.
 PCA
and
continuous
opioid
infusions
are
equally
effective
in
the
treatment
of
pain
in

mucositis,
but
opioid
consumption
is
less
with
PCA
(U)
(Level
I).


SUMMARY
 11. OTHER SPECIFIC PATIENT GROUPS

2.
 PCA
morphine
and
hydromorphone
are
equally
effective
for
the
control
of
pain

associated
with
oral
mucositis
(U)
(Level
II).




The
pregnant
patient


Management
of
acute
pain
during
pregnancy

1.

 Exercises
reduce
back
and
pelvic
pain
during
pregnancy.
There
is
weak
evidence
for

improvements
with
acupuncture
and
chiropractic
care
(N)
(Level
I).


2.

 Use
of
NSAIDs
during
pregnancy
is
associated
with
an
increased
risk
of
miscarriage
(U)

(Level
III‐2).

 For
pain
management
in
pregnancy
non‐pharmacological
treatment
options
should
be

considered
where
possible
before
analgesic
medications
are
used
(U).

 Use
of
medications
for
pain
in
pregnancy
should
be
guided
by
published

recommendations;
ongoing
analgesic
use
requires
close
liaison
between
the
obstetrician

and
the
medical
practitioner
managing
the
pain
(U).

 NSAIDs
should
be
used
with
caution
in
the
last
trimester
of
pregnancy
and
should
be

nd
avoided
after
the
32 
week
(U).

Management
of
pain
during
delivery

1.
 Epidural
and
combined
spinal‐epidural
analgesia
provide
superior
pain
relief
for
labour

and
delivery
compared
with
systemic
analgesics
(S)
(Level
I
[Cochrane
Review]).

2.
 Combined
spinal‐epidural
in
comparison
with
epidural
analgesia
reduces
time
to
effective

analgesia
and
increases
the
incidence
of
pruritus
(U),
does
not
increase
maternal

satisfaction
(R),
but
increases
the
risk
of
urinary
retention
(N)
(Level
I
[Cochrane

Review]).

3.
 Epidural
analgesia
does
not
increase
the
incidence
of
Caesarean
section
or
long‐term

backache
(S)
(Level
I
[Cochrane
Review]).



4.
 Epidural
analgesia
is
associated
with
increased
duration
of
labour
and
increased
rate
of

instrumental
vaginal
delivery
(S)
(Level
I
[Cochrane
Review]).



5.
 Hypnosis
used
in
labour
reduces
analgesic
requirements
(S)
and
improves
satisfaction
(N)

(Level
I
[Cochrane
Review]).

6.
 Acupuncture
reduces
analgesic
requirements
in
labour
(U)
(Level
I
[Cochrane
Review]).


7.
 TENS
may
reduce
severe
pain
in
labour
but
does
not
reliably
reduce
pain
scores
(U)
or

analgesic
requirements
(N)
(Level
I
[Cochrane
Review]).




xliv
 Acute
Pain
Management:
Scientific
Evidence

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