• National GIRFT recommendations for day case surgery state protocols should exist to ensure correct analgesia regimes are prescribed and dispensed according to procedure severity
• Prescribing according to evidence-based guidelines rather than individual clinicians’ preference results in improved analgesia after discharge1
• Standardised, procedure specific TTO regimes will streamline the discharge process
• Personalised TTOs may be required to address individual patient drug allergies and intolerances

The TTO pain management protocol for adults undergoing day case surgery is presented in Appendix A as two tables. Clinicians can select a pre-set combination of drugs relevant to the specific procedure the patient has undergone. These tables have been adopted from recommendations by GIRFT¹ and AoA².

Note: for patients prescribed paracetamol +/- ibuprofen, the nurses will check with the patient if they have an adequate supply at home already prior to dispensing TTO packs of the same medications.

During pre-assessment, patients will be advised to have an adequate supply of simple analgesics at home for use after surgery.

Following day case surgery patients are discharged home by trained nurses. The discharging nurse will inform patients about their take home pain relief medications and how to administer them. Written instructions will be provided in the After Visit Summary (AVS).

Step 1

Choose the relevant procedure from Table 1 to identify the ‘anticipated pain category’

The list is not exhaustive but clinicians, based on their experience, should be able to match any day case procedure to one of the four categories of expected pain intensity.

Step 2

Use the ‘anticipated pain category’ in Table 2 to identify the optimal choice of pain relief take home medications.

The moderate and severe pain categories are sub-divided into TTOs for patients for whom NSAIDs are appropriate and patients for whom NSAIDs are not appropriate*. Certain prescription protocols contain antiemetics, laxatives and PPIs, to alleviate potential side effects of the pain management drugs.

Please note the dosing below applies to patients weighing more than 50 kilograms. It does not take into account individual patients’ drugs allergies or intolerance. In these cases, clinicians will need to prescribe individualised TTO analgesics.

Caution with codeine and morphine sulphate oral solution doses in the elderly, frail and those with impaired renal function.

Consider adding Omeprazole 20 mg once daily, when prescribing ibuprofen for patients who are at high risk of NSAIDs related gastro-intestinal complications.

*Patients who have contraindications or risk factors for NSAIDs.

Table 1

Pain categories for common procedures in the day surgery unit (to be used in conjunction with Table 2)

Table 2

TTO pain relief protocol for day case surgery in adults (weight > 50 kg )

Caution with codeine and morphine sulphate oral solution doses in the elderly, frail and impaired renal function.

Consider adding Omeprazole 20 mg once daily, when prescribing ibuprofen for patients who are at high risk of NSAIDs related gastro-intestinal complications.