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15.1.4 Sedative and analgesic peri-operative drugs

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

 

15.1.4.1 Anxiolytics

 

 

Benzodiazepines

Diazepam

 

 

Lorazepam  (Amber 2)

 

 

Midazolam CD - 2mg in 2mL amp  (Amber 2)

  • 5mg in 5mL amp
  • 10mg in 2mL amp
  • 10mg in 5mL amp
  • 100mg in 50mL vial
  • Epistatus 10mg in 1mL buccal liquid 5mL (U) "Consultant Initiation Only" (Amber 3)

Notes:

  • There have been reports of overdosage when high strength midazolam has been used for conscious sedation. Use should be restricted to general anaesthesia, intensive care, palliative care or other situations where the risk has been assessed.
  • Flumazenil must be kept in all departments that use IV or SC midazolam (NPSA/2008/RRR011).
  • Midazolam is a Schedule 3 CD and must be ordered in the CD order book. 

 

Temazepam   CD

 

 

15.1.4.2 Non-Opioid Analgesic

Note : Since non-steroidal anti-inflammatory drugs (NSAIDs) do not depress respiration, do not impair gastro-intestinal motility, and do not cause dependence, they may be useful alternatives or adjuncts to opioids for the relief of postoperative pain.  NSAIDs may be inadequate for the relief of severe pain.  Diclofenac and ibuprofen are licensed for post-operative use.

Diclofenac

 

Ibuprofen

 

Ketorolac Trometamol

  • 10mg in 1mL amp
  • 30mg in 1mL amp

Note: Licensed for use in short-term management of moderate to severe post operative pain only.

Parecoxib

  • 40mg vial

Notes:

  • Contra indicated in treatment of post op pain following coronary artery bypass graft (CABG surgery)
  • Caution in patients with increased risk of cardiovascular events. 

 

15.1.4.3 Opioid Analgesics

Alfentanil CD

  • 1mg in 2mL amp
  • 5mg in 1mL amp intensive care injection

Note:

  • Intravenous use by anaesthetists and intensive care physicians only due to rapid and profound respiratory depression.
  • Although not included in the original safety alert, the use of 5mg in 1mL amps is subject to the same restrictions as high strength morphine and diamorphine as per NPSA/2006/12

 

Fentanyl CD

  • 100 micrograms in 2mL amp
  • 500 micrograms in 10mL amp

Note: Intravenous use by anaesthetists and intensive care physicians only due to rapid and profound respiratory depression. Intravenous fentanyl Patient Controlled Analgesia (PCA) may only be prescribed on the advice of an anaesthetist or the Acute Pain Team.

 

Remifentanil CD

  • 1mg vial
  • 2mg vial
  • 5mg vial

Note: Intravenous use by anaesthetists and intensive care physicians only due to rapid and profound respiratory depression.

 

 

 

 

Traffic light status explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

 

Return to Chapter: 15. Anaesthesia

Last updated by: Dupe Fagbenro on 11-12-2018 12:05