A 50yo man has had anterior resection of the rectum for carcinoma. He expressed concerns
about control of post-op pain in discussions with the anaesthetist before surgery. What is the
best management strategy?
a. Oral diclofenac
b. Oral codeine
c. IM morphine
d. IM dihydrocodeine
e. Ondansetron oral
answer: C, morphine for post operative analgesia
from the BNF
Postoperative analgesia, a combination of opioid
and non-opioid analgesics is used to treat postoperative pain.
The use of intra-operative opioids affects the prescribing of
postoperative analgesics. A postoperative opioid analgesic
should be given with care since it may potentiate any
residual respiratory depression.
Morphine is used most widely. Tramadol is not as
effective in severe pain as other opioid analgesics.
Buprenorphine may antagonise the analgesic effect of
previously administered opioids and is generally not
recommended. Pethidine is generally not recommended
for postoperative pain because it is metabolised
to norpethidine which may accumulate, particularly in
renal impairment; norpethidine stimulates the central
nervous system and may cause convulsions.
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