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The early management of pain in casualty wards

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Pain is often the main complaint of patients coming into casualty wards but its management is rarely initiated early. Pain management must be considered as an aspect of the general management of the patient coming into the emergency ward [1,3]. It is consequently essential to relieve the pain quickly while continuing the diagnosis [2]. The treatment of pain is a progressive process and there should be no hesitation in combining different drugs with a maximum analgesic benefit while controlling the analgesia in order to avoid secondary effects. The following protocol will allow rapid and reassuring analgesia.


Upon arrival in the ward, the adult patient is dealt with by a nurse who evaluates the analgesic need using the Visual Analogue Scale (VAS). After the consent of the doctor by signing a standard protocol, proparacetamol (2 g IV) and diclofenac (75 mg IV) are administered every 6 and 12 h respectively, irrespective of the VAS level. If the VAS is greater than 3 in the half hour following the initial administration of proparacetamol and diclofenac, the analgesia is completed by subcutaneous morphine (the dose is defined on the written protocol in relation to the weight and age of the patient). This administration must be repeated with an interval of 4 h if the VAS is greater than 3. The contraindications for the different drugs must be respected: chronic renal insufficiency, arterial hypertension with heart failure and gastric ulcers for diclofenac; hepatic insufficiency, atopy, nasal polyps, asthma and eczema for proparacetamol; chronic respiratory insufficiency and drug addiction for morphine.


The cases collected (n=200) show a demographic equivalence (45% women, 55% men) and an average age of 49 years. The distribution of the cases was mainly orthopedic (72%), with renal colic representing 9.6%. Other less common indications made up the remaining 18.4% (neuralgia, arthritis, knife wounds, gout, colitis). The Table shows the VAS over time, from admission up to 28 h (for 63 patients).

The average VAS on admission was 6.02± 2.06.


Using a simple standardized method this protocol allows effective and early management of pain with combined analgesia in a casualty ward.



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Van Trimpont, F., Genard, M. The early management of pain in casualty wards. Crit Care 4 (Suppl 1), P188 (2000).

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