Paediatric Burn: Analgesia

MAJOR BURNS> 15%

• IV morphine 
• is the most widely used analgesia for burns.
• bolus administration dose: 0.1 mg/kg.
• IV morphine continuous infusion dose: <6months: 0-12.5ug/kg/hour,
• >6months: 0-25 ug/kg/hour.
• Paracetamol 
• 15mg/kg QID.
• Low dose ketamine infusion
• improve analgesia if standard doses of morphine do not provide adequate analgesia for pain.

Transition to oral analgesia

• Oral analgesics are started 1-2 hours before infusion/PCA ceased up.

Oral background	Oral breakthrough
MS Contin (suspension or tablets) l  Starting dose 0.6 mg/kg/dose 12 hourly regularly (for opioid naive) l  Consistent mechanism of delivery - avoids potential risk of over sedation when combined with other agents e.g dressing analgesia or sedating antihistamines	Oral morphine (syrup) l  0.2 mg/kg/dose 4 hourly PRN l  Preferred if nasogastric tube is used for administration Or Oral oxycodone (syrup or 5mg capsules) l  >1 year: 0.2mg/kg/dose 4 hourly PRN l  < 1year:0.1 mg/kg/dose 4 hourly PRN l  Preferred if no nasogastric tube used - more palatable

 MINOR BURNS <15%

•  Paracetamol
• 15 mg/kg/does 6 hourly regularly (all children)
• For breakthrough analgesia
• Oxycodone: 
• >1 year: 0.2 mg/kg/dose 4 hourly PRN, <1 year: 0.1 mg/kg/dose 4 hourly PRN
• Ibuprofen: 
• 10 mg/kg/dose 6-8 hourly PRN (cease 48 hours prior to surgery/grafting). Not to routinely prescribe for children <3 months
• Tramadol: 
• 1-2 mg/kg 6 hourly PRN
• For more extensive burns/adequate analgesia: 
• Morphine infusion or PCA with oral analgesia
• MS Contin: 
• 0.6 mg/kg/dose 12 hourly can be used to maintain comfort and facilitates in regular face care

References:

1. Guidelines for the Management of Paediatric Burns, Women’s and Children’s Hospital, 2010.
2. Gandhi, M., Thomson, C., Lord, D., & Enoch, S. (2010). Management of pain in children with burns. International journal of pediatrics, 2010.
3. Krishnamoorthy, V., Ramaiah, R., & Bhananker, S. M. (2012). Pediatric burn injuries. International journal of critical illness and injury science, 2(3), 128.