Tuesday, November 29, 2016

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 pediatrics2010.
  3. Krishnamoorthy, V., Ramaiah, R., & Bhananker, S. M. (2012). Pediatric burn injuries. International journal of critical illness and injury science2(3), 128.

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