|Opiods. Food and Drug Administration, America.|
Opioid Use and Misuse
We still don’t prescribe adequate doses of opioids to patients in acute severe pain (which, generally speaking, are safer than we think). In otherwise healthy patients, we ought to give an appropriate initial dose, and titrate to effect. However, we should also not be surprised if opioids aren’t effective in everyone.
Alternative #1: Ketamine
Ketamine for analgesia is experiencing a surge of interest. It appears to allow for greater pain reduction (or at least limits the amounts of opioids used), and is safe. Consider its use in cases where opioids need to be limited, or where pain is refractory. Its biggest drawback seems to be dysphoric and psychomimetic reactions, however these might be reduced by using a low dose (eg. 0.15mg/kg IV over 10 mins, +/- an infusion of 0.03-0.06mg/kg/hr)
Alternative #2: Lidocaine
IV lidocaine has some evidence to suggest its possible use in the ED, however its unclear mechanism and unfamiliar route of administration is likely to make many physicians uncomfortable. Still, its use might be considered in the specific clinical situations studied, and with sufficient monitoring capabilities and buy-in from colleagues in other departments.