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

  1. AMH Children’s Dosing Companion (2015) Australian Medicines Handbook Pty Ltd
  2. Textbook of Paediatric Emergency Medicine 2nd Edition Cameron Elesevier 2012
  3. 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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