Acute Pain Specialist formulary list
**Other indications for particular drugs may be included on completion of further specialist lists**
The following specialist medicines are approved for prescribing by or on the recommendation of the Acute Pain Team, a prescribing Anaesthetics specialist, or Consultant in Anaesthetics or Pain Medicine (unless otherwise specified):
| TAF SECTION | MEDICINE | SUMMARY OF RESTRICTED INDICATION | CATEGORY | PROTOCOL |
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Ondansetron injection |
1st line treatment of post-operative nausea and vomiting. Prophylaxis of post-operative nausea and vomiting. |
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NHS Tayside Guideline for prophylaxis and treatment of PONV in Adults
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| Ondansetron tablets | 1st line treatment of post-operative nausea and vomiting when oral route available. |
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| Cyclizine injection |
2nd line treatment of
post-operative nausea and vomiting. |
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| Cyclizine tablets | 2nd line treatment of post-operative nausea and vomiting when oral route available. |
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| Dexamethasone injection | Prophylaxis of post-operative nausea and vomiting. |
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| Droperidol injection (Xomolix®▼) | Prophylaxis of post-operative nausea and vomiting. |
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| Diamorphine injection | 2nd line to morphine for use in PCA where side effects with morphine are problematic or in opiate tolerant patients. |
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NHS Tayside Pain Management Guidelines Book
Guidance for management of anticipated complex pain |
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| Fentanyl injection | 1st line for use in PCA in renal insufficiency. 3rd line to morphine for use in PCA where intolerable adverse effects with morphine. |
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NHS Tayside Pain Management Guidelines Book
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| Fentanyl with levobupivacaine for infusion (unlicensed) | For epidural use. |
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Epidural Infusion Analgesia Policy and Management Protocols
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| Fentanyl sublingual tablets (Abstral®▼) | Under the advice of the Acute Pain Team for acute pain on movement or dressing changes in patients unable to tolerate other opioids and where Entonox/Equanox not suitable/available (unlicensed use ‘off-label’). |
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Local treatment protocol for sublingual fentanyl citrate
Treatment algorithm for Abstral |
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| Oxycodone modified release tablets |
2nd line to oral morphine if morphine not tolerated. 1st line opioid for post-operative pain relief in total hip and total knee arthroplasty, and neurosurgery. 1st line for post-operative epidural step-down in general surgery. |
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NHS Tayside Pain Management Guidelines Book
Oxycontin stepdown |
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| Oxycodone injection 10mg/mL | 2nd line to morphine for subcutaneous use if morphine not appropriate under the advice of the Acute Pain Team. |
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| Hydromorphone m/r capsules (Palladone® SR), capsules (Palladone®) | 3rd or 4th line opioid where standard opioids have not been tolerated under the advice of the Acute Pain Team (unlicensed use ‘off-label’). |
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Guideline on the use of strong opioids in chronic non-malignant pain
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| Naloxone hydrochloride injection | Treatment of opioid induced itch, over-sedation and respiratory depression. |
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| 4.7.3 | Pregabalin capsules | Treatment of acute neuropathic pain requiring rapid onset of effect i.e. discitis, under the advice of the Acute Pain Team. Must be reviewed in Pain Clinic after an 8 week trial prior to GP prescribing. |
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Local treatment protocol for pregabalin in acute neuropathic pain (NHS Tayside Staffnet intranet link only) |
| Lidocaine medicated plasters | Treatment of rib fracture pain, under the advice of the Acute Pain Team (unlicensed use ‘off-label’). |
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Local treatment protocol for lidocaine 5% medicated plaster in nociceptive pain (NHS Tayside Staffnet intranet link only) |
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| Capsaicin cream | Treatment of acute on chronic flare up of localised neuropathic pain under the advice of the Acute Pain Team (unlicensed use ‘off-label’) |
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| Ketamine infusion (use only under advice of Pain Team or a Consultant Anaesthetist / Consultant in Pain Medicine) | Management of acute pain in patients with chronic pain in whom multimodal therapies are not providing adequate pain relief, or are producing intolerable side-effects (unlicensed use ‘off-label’). Patients with acute pain who are developing neuropathic pain (unlicensed use ‘off-label’). |
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Guidelines for the use of ketamine infusion in acute pain from the
NHS Tayside Pain Management Guidelines Book
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Lidocaine infusion (use only under advice of Pain Team or a Consultant Anaesthetist/ Consultant in Pain Medicine) |
Acute pain in patients with chronic pain (unlicensed use ‘off-label’). Intractable neuropathic pain not responding to other options (unlicensed use off-label’). |
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Lidocaine infusions in the management of neuropathic pain from the NHS Tayside Pain Management Guidelines Book
Guidance for management
of anticipated complex pain |
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| Clonidine injection | Restricted to use by Anaesthetists only for acute pain in patients with chronic pain or opioid tolerance not responding to other treatment options. (unlicensed use ‘off-label’). |
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| Calcitonin injection |
Treatment of phantom pain unresponsive to other agents, under the advice of the Acute Pain Team (unlicensed use ‘off-label’). Acute neuropathic pain in patients with chronic pain or in complex regional pain syndrome 2nd line to ketamine infusion under the advice of the Acute Pain Team (unlicensed use ‘off-label’). |
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Local treatment protocol
for salmon calcitonin
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| Ascorbic acid | Prevention of chronic regional pain syndrome (CRPS) in trauma patients with chronic pain under the advice of the Acute Pain Team (unlicensed use ‘off-label’) |
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Local protocol for the
use of ascorbic acid in prevention of CRPS |
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For epidural use where fentanyl is not required in the epidural solution. Peripheral nerve blocks or wound soakers (local infiltration analgesia). |
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Epidural Infusion Analgesia Policy and Management Protocols
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| Ropivacaine hydrochloride infusion or injection | Intra-articular peripheral nerve blocks or nerve catheters. |
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| Ephedrine hydrochloride injection or tablets |
Treatment of hypotension in patients
on epidurals |
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| Glycopyrronium bromide injection | Treatment of bradycardia in patients on epidurals |
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May be prescribed by Hospital Specialists only |
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May be prescribed in General Practice under the direction of a Specialist |
