Clinical Practice Guidelines

Analgesia and Sedation

  • See also:         

    Background: 

    Analgesia together with behavioural strategies should be used in all children prior to painful procedures. Sedative drugs may be added as necessary. Play therapy and distraction therapy should be utilised as often as possible to improve the child’s experience. The analgesic ladder is a valuable tool and the table below illustrates this concept. However, in the Emergency Department, an opiate medication may well be the appropriate first line analgesia eg for a deformed limb fracture.      

    Analgesic Route Loading or dose titration Continued dosing Maximum acute dosing
    Sucrose/Glucose PO 0.1 – 0.5 mL 0.1 – 0.5 mL 5 mL
    Paracetamol PO/IV

    20 mg/kg

    (max 1g)

    15 mg/kg (max 1g)

    4 - 6hourly

    60 mg/kg/day

    (max 1g) 6 hourly

    Paracetamol

    Not for use in immunocompromised

    PR

    40 mg/kg

    (max 1g)

    30mg/kg (max 1g)

    4 - 6 hourly

     
    Max 5 grams per day

    Ibuprofen

    Age > 6 months

    PO

    10 mg/kg

    (max 400mg)

    10 mg/kg (max 400mg)

    6-8 hourly with meals

    400mg 8 hourly  
    Oxycodone   PO
    1. – 0.2 mg/kg
    (max 5–10mg)

    0.1 - 0.2 mg/kg

    (max 5-10mg) 4 hourly 

    Usual max 5-10mg 4 hourly; higher and/or more frequent doses may be used
    Morphine IV

    0.1 – 0.2 mg/kg

    (titrate to max 5-10mg)

    Titratable increments 10mg max dose, in severe pain / larger children higher dosing is used
    Fentanyl IN

    Load 1.5 mcg/kg

    (max 7 mcg)

    0.5 - 1.5 mcg/kg

    (max 75mcg) 10 minutely

    3mcg/kg

               

    Other analgesic forms or techniques: 

    • Play therapy or distraction therapy eg iPads, I Spy books
    • Immediate application of splints for potential fractures (commonly overlooked)
    • Ice, elevation, broad arm slings – simple first aid that provides effective analgesia
    • Topical ALA/Laceraine (amethocaine, lignocaine and adrenaline) in preparation for suturing
    • Regional nerve blocks – eg digital ring blocks or femoral nerve blocks
    • Topical anaesthetic creams eg Lignocaine with prilocaine (EMLA), prior to IV insertion or suprapubic aspirate
    • Lignocaine - Phenylephrine (CoPhenylcaine) nasal spray prior to nasal/pharyngeal foreign body removal
    • Lignocaine viscous gel – eg for gingivostomatitis
    • Salicylate teething gels (caution as regards Reye syndrome)
    • Triamcinolone acetonide (Kenalog in Orabase) dental paste for mouth ulcers
    • Methoxyflurane – the ‘green whistle’, very effective but may not be available
    • Topical Amethocaine eye drops for eye pain / abrasions
    • Ketamine is a potent analgesic but is only to be used by experienced practitioners

    Parent information sheet:    

    Information Specific to RCH – Consider referral to Acute Children’s Pain Management Service (CPMS)