Overall PROSPECT Recommendations

Algorithm for the management of postoperative pain

This algorithm for treating postoperative pain is based on the PROSPECT Recommendations and illustrates the different treatment pathways for patients with no contra-indications to epidurals ¢ and patients with contra-indications to epidurals ¢, as well as describing the steps of the peri-operative pathway and therapies that apply to all patients ¢. Therapies that are not recommended are also indicated ¢.

^a     Patients with no contra-indications to epidurals are healthy patients who are not considered to be at a higher risk than is typically associated with epidural anaesthesia
^b     Contra-indications to epidurals include: anticoagulation or coagulopathy, major infection, trauma or burns over injection site, raised intracranial pressure, and hypovolaemia
^c     In patients receiving epidural analgesia, combined use of local anaesthetics and strong opioids is recommended 2–3 days postoperatively, and then after the catheter has been removed systemic strong opioids can be administered for rescue analgesia only