2.5.9.  Analgesia

• Acute pain service advises us on post-surgical pain. The service has transitioned from having “free rein” to being advisory only. 
• IV paracetamol is only used if GIT not accessible. Used to be only under authority of consultant but that is impractical for the night ICU registrar
• Strong preference is for hypotensive patients with epidural post bowel anastomosis is for them to be sent to ICU for vasoactives rather than buckets of fluid and turning epidural off / down with the subsequent pain and mobilisation issues.
• Sedation is usually M&M but trend for more propofol and fentanyl. Use your judgement. Dexmedetomidine available.