Medicine ��� Divisions
whosteps
Hospital Pain Policy and Procedure with References
Three
Step Analgesic Ladder of the World Health Organization* |
Step
1 |
- Acetaminophen 325
-650mg po q4-6h
- Salicylates: ASA
325-650mg po q4h
- NSAIDS (as appropriate)
- Tramadol 50-100mg
po q4-6h
|
Nonopioid
+ or - adjuvant tx |
If pain persists, maximize
nonopioid and add step 2 opiod
Step
2 |
- Codeine 30-90mg po
q4h
- Dihydrocodeine 32mg
po q4h
- Hydrocodone 5-10mg
jpo q4-6h
- Oxycodone 5mg po q6h
|
Opioid:
mild-to-moderate pain + nonopioid + or - adjuvant tx |
If pain persis at step 2, increase
dose of opioid or change to step 3
Step
3 |
- Morphine IR 15-30mg
po q4-6h
- Oxycodone 7.5-10mg
po q4-6h
- Hydromorphone 4mg
po q4h
- Fentanyl 50microgm/hr
x 72hr
|
Opioid:
moderate-severe pain +/- nonopoid +/- adjuvant tx |
*Choose appropriate medication
and adjust appropriately |
World Health Organization
for the 'Three Step Analgesic Ladder '
