Perioperative analgesics

Oral Analgesics

Intravenous Analgesics

ORAL ANALGESICS

  • Paracetamol, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum dose: 4 g in 24 hours.

LoEI [14]

AND

  • Tramadol, oral, 50–100 mg, 4-6 hourly.
    • Avoid in head injury and epilepsy.
    • Improved effect when given with paracetamol.

LoEIII [15]

AND

  • NSAIDs, e.g.:
    • Ibuprofen, oral, 400 mg 8 hourly with meals.

Note: Do not administer NSAIDs to patients at risk of hypovolaemia, renal impairment or gastrointestinal bleeding. Avoid in patients with asthma who experience bronchospasm with NSAIDs.

LoEIII [16]

INTRAVENOUS ANALGESICS

  • Fentanyl, IV, 1–2 mcg/kg
    • Onset ± 3 minutes, duration of action 30–60 minutes. Higher doses last longer.

LoEIII [17]

  • Morphine, IV/IM, 3–5 mg as a single dose then further boluses at intervals of 5–10 minutes and monitor all vitals closely.
    • Dilute 10 mg up to 10 mL with sodium chloride 0.9%.
    • Total maximum dose: 10 mg.
    • Repeat after 4 hours if necessary.
    • Monitor response to pain and effects on respiration and BP.
    • Onset 5-10 minutes. Duration of action ± 3 hours.
    • Histamine release may cause intraoperative hypotension.

LoEIII [18]

  • Ketamine, IV, 0.1–0.3 mg/kg – a subanaesthetic dose given pre-incision

LoEI [19]