• Spinal opioids may only be administered by an Anaesthetist within the theatre suite.
• The surgical medical staff or clinical nurse practitioner should be called for all routine surgical problems.
• In addition the following should be dealt with in the first instance by the ward staff according to current guidelines:
  

  - Hypotension
  - Nausea and vomiting
  - Inadequate analgesia
  - Sedation and respiratory problems
  - Urine retention
  - Itching

• If further advice is required please contact the Acute Pain Nurse (bleep 1003) and if not available, the ITU anaesthetist

• Routine post-op care should be given unless instructed to do otherwise by an anaesthetist.
• Administer oxygen (2 to 4 litres/minute via nasal cannula) only if oxygen saturations ≤ 94%, some patients have a target of 88-92% as per British Thoracic Society Guidance. Ensure that there is a patent IV cannula for 24 hours after the spinal opioid has been administered.

Naloxone (400microgram injection) must be immediately available on the ward. See Naloxone guidance

All observations must be recorded on the NEWs chart if this is in use.

Complications of spinal opioids are related to opioid side-effects. Potentially, patients are at risk of respiratory depression for a much longer period after a spinal dose of opioid compared to patients who have received oral, subcutaneous or intravenous opioids.

• Withhold all other forms of opioids (pain controlled analgesia (PCA), S/C or oral opioids).
• Administer Oxygen at 10 litres/min via a face mask and ensure a clear airway
• Monitor the respiratory rate, sedation score and oxygen saturations every 15 minutes until the respiratory rate is greater than 10 per minute.
• Consider why this has occurred. Review the analgesia and exclude other causes.
• Contact the Acute Pain Service or ITU Anaesthetist for further advice.

• Administer oxygen at 10 litres/min via a face mask and ensure a clear airway.
• Give naloxone 100 micrograms intravenously, see Naloxone guidance
• Contact the ward house officer, the CNP or surgical registrar and stay with the patient.
• Monitor the respiratory rate, sedation score and oxygen saturations every 15 minutes for 1 hour and hourly for 4 hours thereafter, to ensure that respiratory depression does not return. A Naloxone infusion may be required. Contact the ITU Anaesthetist for advice.
• Stop all forms of opioids (PCA, S/C or oral opioids).
• Consider why this has occurred. Review the analgesia prescribed and administered.
• Consider hypovolaemia, cardiac problems, anaphylaxis.
• Contact the ITU Anaesthetist for advice regarding subsequent analgesia, if required.