ANALGESIA GUIDELINES

IS P ETHIDINE
THE BEST CHOICE?
GENERAL PRINCIPLES1 Renal colic2
Consider non-opioids first Rectal NSAIDs as effective

Check time and dose of

last analgesia
as parenteral NSAIDs
Parenteral NSAIDs better

Check for drug dependence

eg methadone
than opioids
Metoclopramide and hyoscine-n-
If opioids required for chronic pain:
butylbromide may also be effective

use oral route

Only use injectable opioids for Biliary colic, pancreatitis3
severe acute pain unrelated to NSAIDs effective in biliary colic
existing chronic pain eg fracture
WHY PETHIDINE IS NOT Use morphine IV or NSAID
RECOMMENDED 2 Morphine preferred (IV/SC for (PR or IM)
titration or repeated doses)
Consider smooth muscle relaxants
Pethidine has a shorter duration Dont withhold analgesia if indicated eg hyoscine-n-butylbromide
of action than morphine with no Treat pain effectively dont No evidence to support use
additional analgesic benet under-dose of pethidine
It has similar side-effects to Observe patient after dosing
morphine, including increased
biliary pressure
Migraine1
1
Back Pain Exacerbation Review
Pethidine is metabolised to
Stepwise approach: effectiveness of
norpethidine, which has potential
- Paracetamol or aspirin previous anti-
toxic effects (eg convulsions),
- NSAIDs or weak opioid migraine therapy
especially in patients with renal
dysfunction (eg codeine) (must be used early)
- If strong opioids required, - Paracetamol or aspirin
Pethidine is associated with use oral route (with metoclopramide)
potentially serious interactions in - NSAIDs (oral / rectal / IM)
Investigate appropriately
combination with other drugs - Triptans, ergotamine
Avoid prolonged
Pethidine is the drug most Rehydrate early
bed rest and
commonly requested by patients
encourage early Consider chlorpromazine if in
seeking opioids, and
return to normal monitored environment
Pethidine is the drug most activity If treated early, strong opioids
commonly abused by health Explain condition not required
professionals
and promote self-management with Treatment failures: morphine IV
non-pharmacological approaches

For further information refer to:

1. NSW Therapeutic Assessment Group. Prescribing Guidelines for Primary Care Clinicians: Rational use of opioids in chronic or recurrent NSW
non-malignant pain (Series: General Principles, Low Back pain, Migraine). Sydney: NSW TAG, 2002. (Online access available via NSW TAG
website, www.nswtag.org.au)
THERAPEUTIC
2. National Health and Medical Research Council. Acute pain management: scientic evidence. Canberra: Commonwealth of Australia, 1999.
(Online access available via NHMRC website, www.nhmrc.gov.au or via link from TAG website)
ASSESSMENT
3. Therapeutic guidelines: Analgesic, 4th ed. Melbourne: Therapeutic Guidelines Limited, 2002. (Online access available to NSW public GROUP
hospitals via CIAP website, www.clininfo.health.nsw.gov.au)