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米国にて内科修行中。何ができるか模索している過程を記録していく

疼痛コントロール

This order set is based on the WHO Analgesic Ladder

Directions:

1. Assess pain severity

2. Begin treatment at the appropriate step of the Ladder

3. If starting at Step 2 or 3 ensure the all appropriate medications from Step 1 are administered in addition to the current step

4. Progress through the steps until pain is controlled

 

STEP 1

- Acetaminophen 650mg PO Q4H PRN for mild pain

 

plus celebrex (with higher risk of bleeding)

- Celecoxib 200mg PO Q12H SCH

 

or ketorolac (with lower risk of bleeding)

- Ketorolac 15mg IV Q6H SCH

(maximum dose of 120mg/day for 5 days. avoid in renal dysfunction, GI bleeding, Platelet abnormality, concomitant administration of ACEI, CHF, cirrhosis, asthma)

 

Mild pain (pain score 1-3)

- oxycodone IR 5mg PO Q4H PRN

- oxycodone oral solution (5mg/5ml 5mg) 5mg PO Q4H PRN

 

STEP 2

Moderate pain (pain score 4-6)

(hydromorphone or oxycodone preferred option)

- Hydromorphone 2mg PO Q4H PRN

- Oxycodone IR 10mg PO Q4H PRN

- Oxycodone oral solution (5mg/5ml 5mg) 10mg PO Q4H PRN

- Morphine IR 15mg PO Q4H PRN

 

Unable to take PO

- Hydromorphone 0.5mg IV Q3H PRN

- Morphine 2mg IV Q3H PRN

 

STEP 3

Severe pain (pain score 7-10)

(hydromorphone preferred option) 

- Hydromorphone 4mg PO Q4H PRN

- Morphine 30mg PO Q4H PRN

 

Unable to take PO

- Hydromorphone 0.5mg IV Q2H PRN

- Morphine 4mg IV Q3H PRN

 

(米国一施設基準)