Pain Relief Paeds

Question 1

What pain relief can we give?

Answer 1

• Paracetamol Oral (15mg/kg)
• Fentanyl (IN/IM)
• Methoxyflurane (Inhaler)
• Morphine (IM)

Question 2

Paracetamol Indications

Answer 2

Headache

Mild pain relief or in conjunction with other analgesic methods

Question 3

Paracetamol Contras

Answer 3

<1mth age

Question 4

Paracetamol Precautions

Answer 4

Hepatoxicity can occur in OD
- do not admin if previously had in 4hrs
- max 4mg in 24hr period (A), 60mg/kg (P)

Question 5

Paracetamol Side Effects

Answer 5

• Hypersensitivity with severe skin rash (rare)
• Haematological reactions
• Hypotension in IV paracetamol especially in critically unwell pts

Question 6

Fentanyl Indications

Answer 6

1. Sedation to facilitate intubation (RSI - modified or Paediatric IFS)
2. Sedation to maintain intubation
3. Sedation to facilitate transthoracic pacing
4. Sedation to facilitate synchronised cardioversion
5. CPR interfering patient - ALS
6. Analgesia – IV/IN
   - History of hypersensitivity or allergy to morphine
   - Known renal impairment / failure
   - Short duration of action desirable
   - Hypotension
   - Nausea and/or vomiting
   - Severe headache

Question 7

Fentanyl Contras

Answer 7

1. History of hypersensitivity
2. Late second stage of labour

Question 8

Fentanyl Precautions

Answer 8

1. Elderly/frail patients
2. Impaired hepatic function
3. Respiratory depression, e.g. COPD
4. Current asthma
5. Patients on monoamine oxidase inhibitors
6. Known addiction to opioids
7. Rhinitis, rhinorrhea or facial trauma (IN route)

Question 9

Fentanyl Side Effects

Answer 9

Respiratory depression
Apnoea
Rigidity of the diaphragm and intercostal muscles
Bradycardia

Question 10

Methoxyflurane Indications

Answer 10

Analgesia

Question 11

Methoxy Contras

Answer 11

Pre-existing renal disease (see Notes below)
Known (or genetic susceptibility) to malignant hyperthermia

Question 12

Methoxy Precautions

Answer 12

Patients should not be administered > 6 mL of methoxyflurane in a 24 hour period, due to
increased risk of nephrotoxicity
To limit occupational exposure, methoxyflurane should not be administered in a confined
space. Ensure adequate ventilation in ambulance. Place used Penthrox inhalers in a closed
plastic bag when not in use.

Question 13

Methoxy Side Effects

Answer 13

CNS: Dizziness, drowsiness
CV: Hypotension
GIT: Nausea and vomiting

Question 14

Morphine Indications

Answer 14

1. Pain relief
2. Sedation to maintain intubation
3. Sedation facilitate intubation (where fentanyl not appropriate for RSI -
   modified or Paediatric IFS)

Question 15

Morphine Contras

Answer 15

1. History of hypersensitivity
2. Renal impairment / failure
3. Late second stage of labour

Question 16

Morphine Precautions

Answer 16

1. Elderly/frail patients
2. Hypotension
3. Respiratory depression
4. Current asthma
5. Respiratory tract burns
6. Known addiction to opioids
7. Acute alcoholism
8. Patients on monoamine oxidase inhibitors

Question 17

Morphine Side Effects

Answer 17

CNS effects:
Drowsiness
Respiratory depression
Euphoria
Nausea, vomiting
Addiction
Pin-point pupils
Cardiovascular effects:
Hypotension
Bradycardia