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)