Pain Management for Small Bowel Obstruction (SBO)

Opioid analgesics are the appropriate first-line treatment for pain management in small bowel obstruction (SBO). 1

Primary Pain Management Approach

Morphine is the recommended opioid for SBO pain management, administered intravenously for rapid pain control 1, 2
The usual starting dose for IV morphine is 0.1 mg to 0.2 mg per kg every 4 hours as needed 2
Administer morphine slowly to avoid complications such as chest wall rigidity 2

Despite traditional concerns, opioids are appropriate for SBO pain management and do not worsen outcomes 1
Morphine is contraindicated in patients with known hypersensitivity, respiratory depression without resuscitative equipment, acute/severe bronchial asthma, or paralytic ileus 2
Have naloxone and resuscitation equipment immediately available when initiating morphine therapy 2

Nasogastric tube decompression should be used for patients with significant distension and vomiting 3
Bowel rest is a cornerstone of non-operative management 1
IV fluid resuscitation is essential to correct dehydration and electrolyte imbalances 3

Anticholinergic agents (scopolamine, hyoscyamine, glycopyrrolate) can help reduce secretions and associated discomfort 1
Octreotide (somatostatin analogue) is particularly useful for reducing gastrointestinal secretions when hyoscine butylbromide fails 4
H2 blockers may be considered for reducing gastric secretions, though evidence is limited 1
Metoclopramide should be avoided in complete bowel obstruction but may be considered for partial obstructions 1

Physical interventions including heat therapy may provide additional pain relief 1
Cognitive-behavioral interventions such as mindfulness-based stress reduction, breathing exercises, and relaxation techniques can be valuable adjuncts 1

For malignant bowel obstruction, a collaborative approach between surgeons, oncologists, and palliative care physicians is recommended 4
Surgical intervention should be considered for strangulation or failed non-operative therapy 3
CT imaging is crucial for determining the cause of obstruction and guiding therapeutic interventions 1, 4

Regular reassessment of pain control and potential complications is essential 2
Monitor for signs of strangulation (fever, hypotension, diffuse abdominal pain, peritonitis) which would necessitate surgical intervention 3
Surgical service evaluation and admission are recommended for patients with SBO 3