Analgesic Management and Escalation
Assess pain, function and current management
0/10
0 No pain10 Worst
Recommended: Plan A
Based on RAS 0 — Plan A. Reassess in 60 minutes.
Reassess after 60 minutes
If pain remains dynamic, escalate to the next plan (Plan B).
If no escalation is required at 60-minute review, consider discharge with analgesia at the discretion of the clinician.
Plan A
Simple analgesia
- •Regular paracetamol PO 1g QDS (500mg QDS if <50kg)
- •Regular codeine PO 30–60mg QDS +/- laxative
- •+/- NSAIDs: ibuprofen PO 400mg TDS unless contraindicated
- •+/- Oral morphine 2.5–10mg PRN (based on age/weight/frailty)
- •+ PRN antiemetic
Plan B
Escalation analgesia
- •Simple analgesia as per Plan A
- •ED only — IV morphine bolus 1–10mg
- •Patient-controlled analgesia (PCA)
- •Refer to Acute Pain Service
- •Admission under orthopaedics
Plan C
Advanced / regional analgesia
- •Simple analgesia as per Plan A
- •Regional anaesthesia referral (Acute Pain Service / Anaesthetist on call)
- •— ESP / Serratus Anterior block or catheter
- •— Thoracic epidural
- •Consider HDU admission
- •Discuss with Major Trauma Centre / Cardiothoracic Surgery
- •Senior escalation
Acute Pain/ Anaesthetic Contact
In hours APS bleep
4270
Anaesthetist on Call
6004