Paediatric Analgesia

Simple Analgesia

• Paracetamol
  Up to 90mg/kg/day above 3/12; 60mg/kg/day in neonates and infants.
  • PO: 20mg/kg load, followed by 15mg/kg Q4H
  • IV: 15mg/kg Q6H
  • PR: 40mg/kg load, followed by 20mg/kg Q6H
• NSAIDS
  
  • Ibuprofen
    Up to 400mg.
    • PO: 5-10mg/kg Q6H
  • Diclofenac
    Up to 50mg.
    • PO: 1mg/kg Q8H

Opioids

• Morphine sulphate PO
  Up to 15mg. Dosing depends on age:
  • <1 month: 80μg/kg Q6H
  • 1-3 months: 100μg/kg Q4H
  • 3-12 months: 200μg/kg Q4H
  • ⩾1 year: 300μg/kg Q2-4H

Infusions

Opioid infusions:

• Are useful in:
  • Young children
  • Physical restriction
  • Developmental delalay
• Are usually prescribed by infusion rate
  Concentration varies depending on weight of child.
• Include:
  • Morphine at 10-40μg/kg/hr
• Should be paired with regular simple analgesia

Patient/Nurse Controlled Analgesia

PCAs in children:

• Can be used when they can:
  • Understand the concept
    Usually over 8 years old.
  • Physically press the button
• Can be nurse-controlled when the child is unable to use it
• Provide psychological benefit by giving agency over analgesia
• Can supplement a background opioid infusion
• Are usually prescribed by a set volume
  Concentration varies depending on weight of child.
• Should be paired with regular simple analgesia

Epidurals

Epidural anaesthesia:

• Usually sited under anaesthesia
• Achieved with continuous infusions:
  • 0.1% or 0.125% levobupivacaine
    
    • ⩽6 months: 0.25mg/kg/hr
    • ⩾6 months: 0.4mg/kg/hr
  • 0.2% ropivacaine
    • 0.4mg/kg/hr
  • Opioids
    Commonly added to infusion.
    • Morphine 1-5μg/kg/hr
    • Fentanyl 0.1-0.5μg/kg/hr

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References