Pain Relief (Adult)

Status

Pain score >2

Determine requirement for Non IV therapy vs IV Therapy

Non IV therapy			IV therapy
Pain likely to be controlled by non IV therapy or unable to obtain IV			Pain may require IV narcotic and ongoing therapy
Consider Methoxyflurane and / or Fentanyl IN if appropriate or while establishing IV access			Morphine up to 5mg IV - Repeat up to 5mg IV 5 minutely titrate to pain or side effects (max 20mg)
Methoxyflurane 3ml - repeat if required (max 6ml)
Assess Pt's Age and Weight			Assess Pt's Weight
If age <60 and >60kg: Fentanyl 200mcg IN - Repeat Fentanyl IN up to 50mcg, 5 minutely titrated to pain or side effects - max dose 400mcg			If unable to obtain IV access and >60kg: Morphine IM 10mg - Repeat Morphine IM 5mg, after 15 minutes (once only) if required
If age >60 and/or <60kg: 100mcg IN - Repeat Fentanyl IN up to 50mcg, titrated to pain or side effects - max dose 200mcg			If unable to obtain IV access and <60kg: Morphine IM 0.1mg/kg - Single dose only - consult for further dose
If pain not controlled by above: Mx as per IV therapy			Morphine as above - no max dose
			If Pt alergic to Morphine:
			Fentanyl IV 25-50mcg - Repeat Fentanyl IV 25-50mcg, 5 minutely titrated to pain or side effects (max. 200mcg)
			Fentanyl as above - no max dose

Nausea

Mx as per Nausea and Vomiting CPG

Special notes

The max of Methoxyflurane is 6ml per 24hr period

IN Fentanyl and / or Methoxyflurane can be considered if IV access is not available or will be delayed

Be cautious of using Fentanyl and Morphine in combination. Smaller doses will be required

If respiratory depression occurs due to narcotic administration - manage as per Overdose

Pts with undiagnosed headache (i.e. new onset sudden severe headache) cannot be given Morphine by Ambulance Paramedics without consultation with a Medical Officer at the receiving hospital. MICA Paramedics may administer Morphine or Fentanyl in this setting without consultation.

ALS Paramedics must consult prior to exceeding the 20mg max dose of Morphine and administer according to Pt need or the onset of side effects

The effect of Morphine IM on pain relief is slow and variable. This route must be used as a last resort and strictly within indicated guidelines

Do not administer IM medication if Pt is likely to receive thrombolysis

Narcotic pain relief should not be administered during late second stage of labour. If narcotics have been administered, Naloxone should not be administered to the newborn.