Analgesia and sedation

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    This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network

  • See also

    Intranasal Fentanyl 


    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


    Not for use in immunocompromised


    40 mg/kg

    (max 1g)

    30mg/kg (max 1g)

    4 - 6 hourly

    Max 5 grams per day


    Age > 6 months


    10 mg/kg

    (max 400mg)

    10 mg/kg (max 400mg)

    6-8 hourly with meals

    400mg 8 hourly

    higher doses (up too 800mg) may be used in the post-operative setting

    Oxycodone   PO

    0.1 – 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 75 mcg)

      0.5 - 1.5 mcg/kg

      (max 75 mcg) 10 minutely

      3 mcg/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 amethocaine, lignocaine and adrenaline (ALA/Laceraine) 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)

      Last updated Feb 2016