Burns - Analgesia and dosing

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Read the full PCH Emergency Department disclaimer.

Aim

To guide PCH ED staff in prescribing analgesia in patients with burns.

General principles

All children with burns will require analgesia
Those requiring admission to hospital will generally require opiates
It is essential that the child has been given appropriate long acting medications prior to transfer to the burns unit.

Management

Medications in the Emergency Department

Pain severity	Drug	Route	Dose	Comments
Severe	Fentanyl	Intranasal	1.5 micrograms/kg via atomiser. Titrate to effect 5 minutely	Fentanyl is the first choice but if not available or IV access attained for other reasons, then use IV Morphine
	Morphine	IV	0.05-0.1 mg/kg. Can repeat 5 minutely until effective	If pain is severe, IV Morphine can be used in addition to IN Fentanyl
	Oral medication (as below)	PO		Give soon after first dose of Fentanyl or Morphine
Mild to moderate	Paracetamol	PO	15mg/kg (maximum dose = 1 gram)
	Ibuprofen	PO	10mg/kg (maximum dose = 400mg)	Not in <3 months old
	Oxycodone	PO	0.05 - 0.2mg/kg (usual maximum dose 5-10mg)

Medication on the Burns Ward

After hours: when child is admitted to the Burns Ward between 2200-0800 hrs please chart the following on ward medication chart:

Drug	Route	Dose	Comments
Morphine elixir	PO	<6 months: 0.25-0.5mg/kg 3-4 hourly PRN >6mths: 0.5-1mg/kg (Max dose 30mg) 3-4 hourly PRN	Please prescribe a range rather than single amount. For dressing changes only.
Paracetamol	PO	15mg/kg 6 hourly (regular, max dose = 1g)	Discuss with pharmacy <3 months old
Ibuprofen	PO	10mg/kg 8 hourly (regular, max dose = 400mg)	For children >3 months age
Oxycodone	PO	0.05-0.2mg/kg, 4 hourly PRN (usual maximum 5-10mg)
Ondansetron	IV/PO	0.15mg/kg 8 hourly PRN (max dose = 8mg)	Maximum 2 doses

Bibliography

AMH Children’s Dosing Companion (2015) Australian Medicines Handbook Pty Ltd
Textbook of Paediatric Emergency Medicine 2nd Edition Cameron Elesevier 2012
Nelson Textbook of Pediatrics: 20th Edition Robert M. Kliegman, Bonita M.D. Stanton, Joseph St. Geme, Nina F Schor Publisher: Elsevier

Endorsed by:	Drugs and Therapeutics Committee	Date:	Dec 2018
Reviewed by:	Meredith Borland (ED Director) Dennis Chow (ED Consultant) Deirdre Speldewinde (ED Consultant) Gabrielle Anstey (ED CNS), Craig Hasler (ED CNM), Tania McWilliams (Burns CNC), Brenda Chapman (Burns CN/SDN) Sandy Chan (Pharmacy), Burns Consultants, Burns/Plastic Consultant	Review date:	Oct 2021

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