ST MARYS ACUTE PAIN SERVICE

Guidelines for the use of drugs with PCA The standard prescription is-IV Morphine Sulphate Other drugs may be selected in specific cases When the PCA is in progress-No strong opioids e.g Morphine,Diamorphlne, Pethidine should be used. Dr Hood also includes the use of Tramadol. A 'Caution with other opioids' Green label should be attached to the front of the prescription chart. The following drugs may be used with a PCAeg. Paracetamol NSAIDS and other adjuvant therapy for some chronic pain conditions eg anticonvulsants Drugs eg Codydramol, Dihydrocodeine and Codeine phosphate may be commenced before stopping the PCA. Where there are particular circumstances where the addition of certain drugs is required, this should be indicated on the prescription sheet by the prescriber.

THE USE OF HEPARIN WITH EPIDURAL ANALGESIA

1. When SC Heparin is given intermittently ( whether standard or low dose) the Epidural Catheter should be removed 12 hours after the last Heparin dose. Restart the Heparin 2 hours after the Epidural Catheter removal.

2. When IV Heparin is given by continuous infusion, stop the infusion and when the APTT is normal, (usually approximately 3 hours), remove the Epidural Catheter and restart the Heparin 2 hours after the Epidural Catheter removal.

3. When Enoxaparin (Clexane) is used in doses which exceed 40mos. The Epidural Catheter should be removed 24 hours after the last dose. Restart the Heparin 2 hours after the Epidural Catheter removal.

PATIENT CONTROLLED ANALGESIA

DRUGS MORPHINE SULPHATE 120MGS IN 120 MLS OF SODIUM CHLORIDE 0.9% IN A PREFILLED BAG.

STANDARD PROTOCOL 1MG EVERY 5 MINUTES WITH A ONE HOUR LIMIT OF 12MGS EACH HOUR. (OTHER DRUGS MAY BE SELECTED FOR THIS ROUTE BY ANAESTHETIC STAFF AND DOSES ADJUSTED ACCORDING TO PATIENT NEED)

ROUTE- INTRAVENOUS

THE PRESCRIPTION WILL BE DOCUMENTED BOTH ON THE DRUG PRESCRIPTION CHART AND THE PCA OBSERVATION CHART.

'MICROGRAMS' SHOULD BE WRITTEN IN FULL

ANALAGESIA DEVICE BAXTER AP11 OR BAXTER 1' PUMP. ACUTE PAIN SERVICE

Guidelines for the use of drugs when Epidural analgesia in progress

It is not recommended that other strong opioids be used when the Epidural is in progress.

The following should be avoided-Pethidine, Morphine, Diamorphine. Dr Hood also includes the use of Tramadol.

Before stopping the Epidural, the following may be introduced, Dihydrocodeine, Codeine phosphate, Codydramol.

The use of Paracetamol is acceptable when the infusion is in progress.

Where particular circumstances require the addition of certain drugs, this should be indicated on the prescription sheet by the prescriber.

GUIDELINES FOR CLEARING AIR FROM PCA AND EPIDURAL CATHETERS

PATIENT CONTROLLED ANALGESIA Nurses who are IV trained may carry out the following Using an aseptic technique, detach the giving set from the Venflon making sure that it is sealed with a sterile hub. Insert the key in the pump to programme priming. Once the line has cleared of air, return to the original programme which the pump will have retained. Do not restart the pump until details of the original programme are displayed EPIDURAL ANALGESIA Nurses who have completed Epidural Training may carry out the following. Using an aseptic technique, detach the giving set from the filter .and make sure that the filter is sealed with a sterile hub. Insert the key into the pump to programme priming. Once the line has cleared of air, return to the original programme which the pump will have retained. Do not restart the pump until details of the original programme are displayed .

IF YOU HAVE CONCERNS ABOUT THE OPERATION OF THE PUMP, PLEASE ASK FOR HELP FROM SOMEONE WHO IS FAMILIAR WITH IT.

JRH/PM (these guidelines have been approved by Dr.J.Hood Consultant in Anaesthetics and Acute Pain)