Analgesia Anaesthesia section (Pain in the Emergency Department)
Analgesia anaesthesia section
Assessment
- Pain Score in isolation is NOT useful
- Need also to consider findings of catecholamine surge.
- Raised BP, HR, RR, Sweating, Flushed, Nausea
- Distress is distress, perhaps (not always) secondary to pain
- Treat distress with appropriate small doses of anxiolytics and you will lower your analgesic requirement
- BUT… anxiolytics themselves are NOT a treatment for pain!
- Different types of pain required different approaches
- Try to working out where the pain is coming from
Establish an Analgesia Base
- Paracetamol and NSAID (if not contraindicated) for all
Manage the Source of pain
Nociceptive Pain (i.e. Normal pain associated with acute injury/insult)
- Epigastric Pain: PPI or H2 Receptor Antagonist (i.e. Zoton Fastab MADE IN IRELAND)
- Cramping Pain: Hyoscine Butylbromide (Buscopam)
- Is the patient constipated? (Movicol, Microlette, etc.)
- Inflammatory Pain: (NSAIDs, or Steroids) +/- Antihistamine
- Bone / Muscle Pain: ie. acute injury – see separate section
- Nausea and Vomiting/ Retching Pain: NG tube +/- Anti emetics
Neuropathic Pain (ie. Chronic, abnormal processing of sensory input)
- For chronic, please see Neuropathic Pain page
- Assessment is important: Is this new pain because the patient is constipated? Gastritis? Injured?
- Antidepressant and Antiepileptics have role (has the patient recently stopped them?)
- Is the patient still taking their Paracetamol + NSAID (i.e. baseline).
- Better for the patient to be given Breakthrough pain relief and to see Pain Team in elective setting for objectivity
When to reach for Strong Opiates (Morphine preparations)
- In Acute Visceral Pain
- ONLY once all of the above options have been utilised
- Titrate to response
In Neuropathic Pain
Managing Injuries in the Emergency Department
- Decide how you are going to TREAT the pain!
- Reduce, Splint, Cover or Irrigate?
- Analgesia Base
- Paracetamol + NSAID +- Simple opioid (codeine NOT Morphine)
- Procedural Analgesia and Sedation
- See separate Sedation Policies for Adults and Children
- Short acting opiates such as Fentanyl for the procedure itself +/-
- Short acting Hypnotic (e.g. See policy)
or
- Regional Anaesthetic technique
- Treat the pain
- Dislocations: Reduce
- Fractures: Splint
- Burns: Cover from air
- Irritant: Irrigate
- Post Treatment Options
- Maintain Analgesia Base
- Consider Codeine/Paracetamol preparations (Solpadine 8/500 or Solpadol 30/500)
- Splinting/Strapping/Immobilise
- Going to theatre/in-patient: Consider Long acting Opiate (Morphine)
