SUSTAIN For PAIN

Exclusion Criteria24

• Plan for epidural and/or spinal analgesia.
• Surgeon or anaesthetist refusal to placement of catheters.
• Inability to communicate in English due to a language barrier, cognitive deficit or intellectual disability.
• Inability of patient to use patient controlled analgesia (PCA) pump postoperatively or to understand visual analogue pain score.
• Patients flagged for postoperative ventilation.
• Asthma if exacerbated by non-steroidal anti-inflammatory drugs (NSAIDs) or asthma if a patient has never taken a NSAID.
• Acute abdomen, with clinical signs of abdominal peritonism.
• Septicaemia involving positive bacterial blood cultures.
• Localised infection at the site of proposed needle insertion.
• Opioid tolerant patients, i.e. any of the following:
• Patient taking an average of 8 Panadeine Forte tablets per day for a greater than one week.
• Patients taking greater than 40 mg oxycodone per day for greater than one week.
• Patients receiving 20 mg morphine parenterally per day for greater than one week.
• Patients on a fentanyl patch of dose greater than 12.5 mcg/hour for greater than one week.
• Any patient receiving buprenorphine.
• Any patient receiving methadone.
• Any patient receiving naltrexone or naloxone as part of an opioid abstinence program.
• Any history of injected or inhaled illicit drug use in the previous six months.
• A clinical history of chronic pain, where patients may benefit from early commencement of ketamine.
• Renal impairment with creatinine clearance less than 60 mL/min.
• Severe hepatic impairment (Child-Pugh score greater than or equal to 10).
• Patients with unstable or uncontrolled epilepsy.
• Allergy or contraindication to morphine, ropivacaine, tramadol, parocoxib, sulphonamides or paracetamol.
• Patients on ketaconazole, fluconazole, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), serotonin noradradrenaline reuptake inhibitors (SNRIs), tricyclic anti-depressents, carbemazepine, quinidine, antipsychotics, zidovudine or warfarin.