Paediatric Pain Relief CPG

Question 1

What must you asses for a pt’s complaint of pain?

Answer 1

• Reported level of pain (using appropriate pain scale)
• Physical signs of discomfort (and document)
• Acute vs chronic
• Analgesia already taken
• Opioid tolerance
• Co-morbidities

Question 2

What are the three categories of pain?

Answer 2

Mild, Moderate & Severe

Question 3

Describe your actions for someone suffering from Mild pain

Answer 3

• Paracetamol 15 mg/kg oral if not already taken in the past 4 hours
• If elderly or frail, weight ≤ 60 kg, malnourished or liver disease - Paracetamol 500 mg oral
  If pain not controlled or rapid pain relief required, consider treating as per Moderate pain

Question 4

Describe your actions for someone suffering from Moderate pain

Answer 4

Fentanyl IN
- Small child (10 - 17 kg) Fentanyl 25 mcg IN
- Medium child (18 - 39 kg) Fentanyl 25 - 50 mcg IN
- Large child (≤ 40 kg) Fentanyl 50 mcg IN
- Repeat initial dose at 5 - 10 min intervals titrating to pain or side effects (max 3 doses)
Consult with RCH for doses in children < 10 kg
If unable to administer Fentanyl IN
- Methoxyflurane 3 mL inhaled, repeat 3 mL if required, max 6 mL

Question 5

Describe your actions for someone suffering from Severe pain

Answer 5

• Fentanyl IN or Methoxyflurane as per Mod pain
• Consider Morphine IM as a last resort if pain not controlled by above and unable / not accredited to gain IV access
• Morphine 0.1 mg/kg IM single dose only. Consult with RCH or receiving hospital for further doses