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IV PCA
COX-2s: Parecoxib
Recovery Pain Protocol
Paracetamol
IV: Fentanyl, PO/IV COXIBs
Opioids: Morphine
Alfentanil, Morphine PO/PR Paracetamol
NSAIDs: Diclofenac,
PO COXIBs/NSAIDS: Ketorolac, Ibuprofen PO/PR NSAIDs
Ibuprofen, Celecoxib
NMDA: Ketamine Pain Buster Soakers
NorAdr/5HT: Tramadol Pregabalin
Local Anaesthetics PCEA
Risk Factors for Chronic Post-Surgical Pain
Preop Risk Factors Pain (moderate – severe) lasting >1month
Repeat surgery
Psychological vunerability
Workers’ compensation
Intraop Risk Factors Surgical approach with risk of nerve injury
Postop Risk Factors Acute pain (moderate – severe)
Radiation therapy to area
Neurotoxic chemotherapy
Depression
Psychological vulnerability
Neuroticism Stephen Gatt
Anxiety
• Bolus: 0.5-2.0mg
Fentanyl
100mcg/mL
• Prepare 2x500mcg amp in 10 mls
• Remove 20mls from 100mL bag of N/S
• Bolus: 10-20mcg
Pethidine
• 10mg/mL
• Prepare 2x500mg amp in 10mls
• Remove 20mls from 100mL bag of N/S
• Bolus: 10-20mg
• Norpethidine toxicity: <800mg
Ketamine Infusion
• 200mg in 50ml via syringe driver
– IV in acute pain
– Subcut in chronic pain
2mL/hr
OR
• Diclofenac and ibuprofen are used almost universally off-label in most countries for
post-CS pain.
• Once the infant is delivered, there is little risk of (and much benefit from) closure of
the ductus arteriosus.
• It does not interfere with the epidural/intrathecal analgesia and allows for a ‘soft’
transition from major neuraxial blockade to simple oral analgesia.