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Guidelines : Pain
Additional Documents
Other Drugs
- Co-proxamol (Dextropropoxyphene hydrochloride/para
- Ziconotide acetate
- Oxycodone
- Co-codamol
- Tramadol with paracetamol
- Oxycodone with naloxone
- Fentanyl
- Tramadol hydrochloride
- Tramadol with Dexketoprofen
- Paracetamol
- Codeine phosphate
- Dihydrocodeine tartrate
- Buprenorphine
- Morphine sulfate
- Pregabalin
- Gabapentin
- Cannabis (medicinal)
- Co-dydramol 10/500
- Sufentanil
- Ibuprofen
- Meptazinol hydrochloride
- Pethidine hydrochloride
- Diamorphine hydrochloride
- Methoxyflurane
- Alfentanil hydrochloride
- Co-dydramol 20/500
- Co-dydramol 30/500
- Nefopam hydrochloride
- Papaveretum
- Aspirin
- Parecoxib sodium
- Ketamine
Committee Recommendations
The Centre for Perioperative Care position statement on Modified Release Opioids - was agreed for use within Surrey Heartlands to support the safe use of opioids after surgery. See link
https://cpoc.org.uk/sites/cpoc/files/documents/2023-05/CPOC%20MR%20Opioid%20statement.pdf
Prescribing weight-adjusted oral paracetamol in adults - British Hepatology Pharmacy Group Position Statement - was agreed for use within Surrey Heartlands to support the safe use of paracetamol. See link below.
The ‘OPIOID PATCH INFORMATION TO KEEP PATIENTS SAFE' leaflet for patients and 'OPIOID PATCH SAFETY: COUNSELLING CHECKLIST’ for healthcare professionals were agreed for use within Surrey Heartlands to support the safe use of opioid patches. See documents below.
The local guidelines for persistant non-malignant pain have been updated . A link to the opioid dose conversion from the Faculty of Pain Medicine has been included (Appendix 5) and a link is also provided below for reference- see guidelines and other pain resources below
The Surrey & Sussex Area Prescribing Committee have made recommendations in relation to paracetamol dosing in frail elderly patients.
There have been some case reports of liver failure associated with therapeutic doses of paracetamol in some patients. Frail elderly patients with a body-weight < 50kg and those with risk factors for hepatotoxicity such as cardiac, pulmonary and renal insufficiency in conjunction with old age, co-administration of medicines that induce liver enzymes, hepatitis and chronic alcohol consumption.
The BNF recommends that clinical judgement should be used to adjust the dose of oral paracetamol in such patients. The clinicians may choose to either reduce the dosage or the frequency of administration of paracetamol. Co-administration of enzyme-inducing medications may also increase toxicity; paracetamol doses should be reviewed and reduced.
NOTE: Patients having IV paracetamol will already have had adjustments made based on body weight so no further adjustment should be required.