The Analgesic Ladder describes three stages:

• Stage 1 - simple analgesics
• Stage 2 - simple analgesics + mild opioids +/- NSAIDs
• Stage 3 - simple analgesics +/- NSAIDs + strong opioids

Stages 2 and 3 are most commonly used to provide intraoperative analgesia. Simple analgesics, such as paracetamol, and NSAIDs, such as diclofenac and ibuprofen, may provide sufficient analgesia for short, day-case analgesia, sometimes in combination with local anaesthesia.

For more painful surgery an opioid is used. Fentanyl is the most commonly used intraoperative opioid. It is useful to combine simple analgesics and NSAIDs with fentanyl to reduce the total dose of opioid required, and provide a degree of postoperative analgesia, as well as to limit unwanted effects of opioids.

If local or regional anaesthesia is also used, the opioid requirements will be markedly reduced.