Assessment

• Subjective: ask patient to rate 1-10
• Objective: tachycardia, tachpnoea, HTN, sweating, flushing

NSAIDS

Side effects (I-GRAB):

• Interactions with other medications (such as Warfarin)
• Gastric ulceration (consider adding a PPI when prescribing NSAIDs long-term)
• Renal impairment (use NSAIDs sparingly in those with poor renal function)
• Asthma sensitivity (triggers 10% of individuals with asthma)
• Bleeding risk (due to their effect on platelet function)

Opioids

• prescribe laxatives and anti-emitics concurrently
  • Stimulant laxative (senna)
• For regular opirates - always prescribe concurrent paracetamol to reduce their requirement
• If opioid analgesia is required in a patient with renal impairment, consider using oxycodone or fentanyl rather than morphine
• If the oral route is contraindicated, consider topical patches and use IV morphine for breakthrough analgesia, as the bioavailability of oral morphine is 30% whereas it is 80% for IV or SC morphine
  • Morphine takes approximately 2-3 minutes to work if given intravenously, 20 minutes if taken orally, and 15 minutes if given intramuscularly

Epidural analgesia