ED Opiate-Free Pain Options by Indication
| Musculoskeletal Pain: Acute on Chronic Opiate-Tolerant OR Acute Opiate Naïve |
|---|
| No IV access - Intranasal Ketamine 50mg (0.5ml) |
| Acetaminophen 1000mg PO/IV |
| Ibuprofen 600mg PO or Ketorolac 15mg IV/IM |
| Trigger Point injection - Lidocaine 1% 1-2ml subQ |
| Cyclobenzaprine 5mg PO or Diazepam 5mg PO/IV |
| Dexamethasone 8mg PO/IV |
| Ketamine 0.2mg/kg IV over 5-10 min |
| Lidoderm patch to most painful area (Max 3 patches) |
| Gabapentin 300mg PO (neuropathic component of pain) |
| Abdominal Pain |
|---|
| Metoclopramide 10mg IV |
| Diphenhydramine 25mg IV |
| Promethazine 25mg IV |
| Dicyclomine 20mg PO |
| Haloperidol 2.5mg IV over 5 min |
| Lidocaine 1.5mg/kg in 100ml NS over 10 min (Max 200mg) |
| Ketamine 0.2mg/kg in 50ml NS IV over 5-10 min |
| Sumatriptan 6mg subQ |
| Capsaicin 0.025% topical |
| Renal Colic |
|---|
| Acetaminophen 1000mg PO/IV |
| 1 liter Normal Saline bolus |
| Ketorolac 15mg IV |
| Lidocaine 1.5mg/kg in 100ml NS over 10 min (Max 200mg) |
| Intranasal Ketamine 50mg (0.5ml) |
| Recurrent Primary Headache/Migraine |
|---|
| Acetaminophen 1000mg PO/IV |
| Ibuprofen 600mg PO or Ketorolac 30mg IV/IM |
| 1 liter Normal Saline bolus |
| Sumartriptan 6mg subQ |
| Cervical or trapezius trigger point injection with Lidocaine 1% 1-2ml IM |
| Metoclopramide 10mg IV |
| Promethazine 12.5mg IV |
| Magnesium 1gm IV over 60 min |
| Valproic Acid 500mg/50ml NS IV over 20 min |
| Levetiracetam 1000mg/100ml NS IV over 15 min |
| Dexamethasone 8mg IV (migraine only) |
| Haloperidol 2.5mg IV over 5 min |
| Lidocaine 1.5mg/kg in 100ml NS over 10 min (Max 200mg) |
| If tension component - Cyclobenzaprine 5mg PO or Diazepam 5mg PO/IV |
| Extremity Fracture or Joint Dislocation |
|---|
| Consider regional anesthesia: e.g. nerve blocks: wrist, ankle, ulnar, radial, etc. |
|
Immediate therapy: (steps 1-3 while setting up for block)
Followed by setting up for:
If unable to do ultrasound-guided regional anesthesia:
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