Module 11 Flashcards
What is the ‘analgesic ladder’?
Describe how the analgesic ladder impacts the choice of pain relief you give your patient.
Medications should be administered in standard dose at regular intervals for persistent pain, beginning with simple analgesia such as paracetamol.
If pain is not controlled the dose is adjusted or a co-analgesic is commenced in combination with the paracetamol until pain is controlled.
Combination of medications may be better tolerated than one high dose of a single drug.
Ladder:
Start with simple analgesic, given regularly ‘around the clock’.
If pain persists or increases consider addition of co-analgesic. Anti-inflammatory may be required for a short period.
If pain persists or increases change to a weak opioid. Continue paracetamol and co-analgesic if indicated. Add a laxative.
If pain persists or increases adjust dose of weak opioid. Continue paracetamol and co-analgesic if indicated. Continue laxative.
If pain persists or increases change to strong opioid. Continue paracetamol and co-analgeic if indicated. Continue laxative.
Titrate strong opioid dose to patient needs. Continue paracetamol, co-analgesic and laxative.
List the ways analgesic medication can be given and the benefits of each route.
Oral analgesia
Advantages: ease of administration; reduced duration of hospitalisation and health care costs.
Disadvantages: therapeutically unreliable; limited choice of agents; capacity for replacement of prolonged parenteral therapy is controversial.
Parenteral analgesia
Advantages: Antibiotic delivery to areas that cannot be reached with oral therapy; choice of large set of agents; arrest or eradication of infection in most cases (with surgical debridement)
Disadvantages: often requires hospitalisation; lack of patient compliance; systemic drug toxicity; expensive; relapse of bone infection not uncommon even with prolonged courses of IV antibiotic therapy.
Local analgesia
Advantages: Avoid high serum concentration of antibiotic; delivers straight to infection site; reduces hospital stay and costs
Disadvantages: Lack of proven efficacy in good randomised clinical trials.
Your patient is in pain 1 hour after being given paracetamol 1g, PO. What do you do?
Conduct pain assessment and provide adjuvant analgesia.
Consider non-pharmacological interventions such as heat/cold pack, positioning.
Your patient has been taking paracetamol and ibuprofen at the same time. Is this a problem?
No.
Concurrent use within recommended dosing is safe and effective, and reduces the need for opiates.
How can you assess the level of pain when:
Your patient is in a coma?
Nociception coma scale
Review heart rate, blood pressure and respirate rate and quality.
Increase in peripheral tone.
How can you assess the level of pain when:
Your patient does not speak English
Visual pain assessment scale (VAS)
Interpreter.
How can you assess the level of pain when:
Your patient is an infant
Neonatal pain assessment tool.
How can you assess the level of pain when:
Your patient describes pain as 10/10 but you suspect drug seeking
Functional pain assessment
Pain history
