Paediatric Pain Relief

Question 1

What is the RCH’s preferred analgesia option in most cases for ALS/MICA paramedics?
If maximum dosing reached but pt remains in pain, can consultation occur for further doses?

Answer 1

IN Fentanyl.

Yes, consult for further doses.

Question 2

If IN Fentanyl insufficient in extreme traumatic pain, what is the RCH’s preferred treatment?

Answer 2

Ketamine +/- opioids, rather than IV opioids alone.

Question 3

Can IM Morphine be administered to a child by ALS paramedics?

Answer 3

Yes - 0.1mg/kg. single dose as a last resort.

Question 4

Can Methoxyflurane be used as a sole analgesic in paediatrics?

Answer 4

No, is an adjunct for procedural pain only, unless IN Fentanyl unable to be administered.

Question 5

In which paediatric patients may analgesia be achieved with a single dose of IN Fentanyl?

Answer 5

1 - 2 years.

Question 6

What is the dosing calculation for paracetamol in children?

Answer 6

15mg/kg.

Question 7

In children aged 10 and 11, what alternative can be given to liquid paracetamol?

Answer 7

1 x 500mg paracetamol tablet.

Question 8

What are the appropriate non-pharmacological pain management options for children?

Answer 8

1. Distraction therapy
2. Splinting
3. Cold/heat therapy

Question 9

What is the treatment option for mild pain in paediatrics?

Answer 9

15mg/kg paracetamol orally, if not given in <4hrs and request by parent/carer.

Question 10

What is the treatment option for moderate pain in paediatrics?

In what 2 circumstances will RCH consultation be required?

Answer 10

Fentanyl IN
Small child (10 to 17kg) = 25mcg IN
Med child (18 to 39kg) = 25 - 50mcg IN

Rpt initial dose at 5 - 10 min intervals, max. 3 doses.
Consult RCH if pt <10kg, or if further doses required.

Consider paracetamol in combination.

Question 11

If unable to administer Fentanyl IN or Moderate/Severe procedural pain, what analgesic option is available for paediatric pain relief?

Answer 11

Methoxyflurane, 3mL + 3mL, as per adults.

Max. 6mL.

Question 12

What is the treatment option for Severe Pain in paediatric patients?

Answer 12

Fentanyl IN +/- Methoxyflurane as per Moderate Pain, consult for further Fentanyl as required.

Question 13

Opioids in paediatric pts should be titrated to?

Answer 13

Pain or side effects.

Question 14

What is the presentation of liquid paracetamol, and what is the dosing regime for a child?

Answer 14

120mg/5mL or 24mg per 1mL.

Dose at 15mg/kg.