Acute pain

Acute Pain Specialist formulary list

**Other indications for particular drugs may be included on completion of further specialist lists**

For information on use of unlicensed medicines or medicines used 'off-label' - click here

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):

MEDICINE	SUMMARY OF RESTRICTED INDICATION	CATEGORY	PROTOCOL
Ondansetron injection	1^st line treatment of post-operative nausea and vomiting. Prophylaxis of post-operative nausea and vomiting.		NHS Tayside Guideline for prophylaxis and treatment of PONV in Adults (NHS Tayside Staffnet intranet link only)
Ondansetron tablets	1^st line treatment of post-operative nausea and vomiting when oral route available.
Cyclizine injection	2^nd line treatment of post-operative nausea and vomiting. Prophylaxis of post-operative nausea and vomiting.
Cyclizine tablets	2^nd line treatment of post-operative nausea and vomiting when oral route available.
Dexamethasone injection	Prophylaxis of post-operative nausea and vomiting.
Droperidol injection (Xomolix^®▼)	Prophylaxis of post-operative nausea and vomiting.
Diamorphine injection	2^nd line to morphine for use in PCA where side effects with morphine are problematic or in opiate tolerant patients.		NHS Tayside Pain Management Guidelines Book Guidance for management of anticipated complex pain (NHS Tayside Staffnet intranet links only)
Fentanyl injection	1st line for use in PCA in renal insufficiency. 3^rd line to morphine for use in PCA where intolerable adverse effects with morphine.		NHS Tayside Pain Management Guidelines Book
Fentanyl with levobupivacaine for infusion (unlicensed)	For epidural use.		Epidural Infusion Analgesia Policy and Management Protocols (NHS Tayside Staffnet intranet links only)
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’).		Local treatment protocol for sublingual fentanyl citrate Treatment algorithm for Abstral^® for incidental pain (NHS Tayside Staffnet intranet links only)
Oxycodone modified release tablets	2^nd line to oral morphine if morphine not tolerated. 1^st line opioid for post-operative pain relief in total hip and total knee arthroplasty, and neurosurgery. 1^st line for post-operative epidural step-down in general surgery.		NHS Tayside Pain Management Guidelines Book Oxycontin stepdown Local treatment protocol for Oxycodone MR in the acute pain setting (NHS Tayside Staffnet intranet links only)
Oxycodone injection 10mg/mL	2^nd line to morphine for subcutaneous use if morphine not appropriate under the advice of the Acute Pain Team.		NHS Tayside Pain Management Guidelines Book
Hydromorphone m/r capsules (Palladone^® SR), capsules (Palladone^®)	3^rd or 4^th line opioid where standard opioids have not been tolerated under the advice of the Acute Pain Team (unlicensed use ‘off-label’).		NHS Tayside Pain Management Guidelines Book (for dose conversion chart). Guideline on the use of strong opioids in chronic non-malignant pain (NHS Tayside Staffnet intranet links only)
Naloxone hydrochloride injection	Treatment of opioid induced itch, over-sedation and respiratory depression.		NHS Tayside Pain Management Guidelines Book Epidural Infusion Analgesia Policy and Management Protocols
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.		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’).		Local treatment protocol for lidocaine 5% medicated plaster in nociceptive pain (NHS Tayside Staffnet intranet link only)
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’)
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’).		Guidelines for the use of ketamine infusion in acute pain from the NHS Tayside Pain Management Guidelines Book Guidance for management of anticipated complex pain (NHS Tayside Staffnet intranet links only)
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’).		Lidocaine infusions in the management of neuropathic pain from the NHS Tayside Pain Management Guidelines Book Guidance for management of anticipated complex pain (NHS Tayside Staffnet intranet links only)
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’).
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 2^nd line to ketamine infusion under the advice of the Acute Pain Team (unlicensed use ‘off-label’).		Local treatment protocol for salmon calcitonin (NHS Tayside Staffnet intranet link only)
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’)		Local protocol for the use of ascorbic acid in prevention of CRPS (NHS Tayside Staffnet intranet link only)
Fentanyl patch	For post-operative epidural step-down in general surgery where patients remain nil by mouth under the advice of the Acute Pain Team.		Guideline for the use of transdermal fentanyl patch for epidural stepdown analgesia (NHS Tayside Staffnet intranet link only)
Levobupivacaine infusion or injection	For epidural use where fentanyl is not required in the epidural solution. Peripheral nerve blocks or wound soakers (local infiltration analgesia).		Epidural Infusion Analgesia Policy and Management Protocols NHS Tayside Pain Management Guidelines Book (NHS Tayside Staffnet intranet links only)
Ropivacaine hydrochloride infusion or injection	Intra-articular peripheral nerve blocks or nerve catheters.		NHS Tayside Pain Management Guidelines Book
Ephedrine hydrochloride injection or tablets	Treatment of hypotension in patients on epidurals (tablets – unlicensed use ‘off-label’)		Local treatment protocol for the use of oral ephedrine Epidural Infusion Analgesia Policy and Management Protocols
Glycopyrronium bromide injection	Treatment of bradycardia in patients on epidurals		Epidural Infusion Analgesia Policy and Management Protocols

Traffic light status information
	To be prescribed by Hospital Specialists Only.
	Can be prescribed in General Practice under the direction of a Specialist.