Analgesic Pain Management

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The choice of the pain management strategies depends on different factors including the site and the nature of the surgery, type and intensity of pain, co-morbidities and the ongoing clinical condition of the patient.
As described earlier, whilst satisfactory pain relief is essential for the recovery of the critically ill patients, care should be exercised to ensure that the analgesic techniques do not deteriorate the condition (e.g. hypotension with epidural, respiratory depression with opioids, renal impairment with Non-steroidal anti-inflammatory drugs [NSAIDs]).
The management options can grossly be categorised to:
1. Analgesic medications (Paracetamol, NSAIDs, Opioids etc.)
2. Regional analgesic techniques (Local Anaesthetics +/- Opioids)

Commonly, a combination of medications / local anaesthetic techniques is employed for safe and effect pain relief. The World Health Organisation analgesic ladder was introduced to improve cancer pain control. The concept is extrapolated to other pain conditions as well – as the intensity of the pain increases, the complexity of the interventions also increase.
1. Step 1: Simple analgesics (Paracetamol +/- NSAIDs)
2. Step 2: Weak Opioids (such as Codeine) +/- Simple analgesics
3. Step 3: Stronger Opioids (such as
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where nerves are injured), conventional analgesics may not provide satisfactory relief. The issue is further compounded if the patient has past history of chronic pain. Regional analgesic techniques (discussed below) can help. When traditional interventions fail, co-analgesics such as anticonvulsants (e.g. gabapentin), antidepressants (e.g. amitriptyline) or Ketamine (5-10 mg per hour intravenous infusion) may be used. It is prudent to seek help from the hospital acute pain team prior to embarking on less conventional approaches to manage
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