Pain Relief (Paeds) CPG Notes Flashcards
(29 cards)
What is the main goal of paediatric pain management?
To reduce suffering to a level that the patient is comfortable.
What is the most important indicator of adequate analgesia?
The patient reporting comfort.
Should pain relief be withheld from patients who can’t report or rate pain?
No. If discomfort is evident, analgesia should be strongly considered.
What patient groups may be unable to report or rate pain?
- Children
- Patients with intellectual disability
- Non-English speakers
- Very young children
Which IN medication is established as safe and effective for paediatrics, even in severe pain?
Fentanyl IN.
When the maximum dose of Fentanyl IN has been reached and pain persists, what should you do?
Consult AV Clinician for further doses.
Why should fentanyl IN be split between nostrils?
To maximise absorption.
What is the maximum volume per nostril for IN medication?
1 mL per nostril per dose.
Should you add extra volume to prime the mucosal atomiser device?
No, not routinely. Only consider adding 0.1 mL for very small doses.
What should be considered if fentanyl IN is insufficient for severe pain?
IV ketamine ± IV opioids (rather than IV opioids alone).
When is it appropriate to give paracetamol with opioids?
In moderate pain, if oral route is not contraindicated.
Is morphine IM preferred in paediatric pain?
No – it’s slow and variable. Use only as a last resort when IN and IV are unavailable.
What is the maximum dose of morphine IM in children?
0.1 mg/kg, not to exceed 5 mg (unless child is heavier than age-calculated weight).
How should opioids and ketamine be titrated?
To pain relief or side effects.
What is often sufficient for children aged 1–2 years?
A single dose of fentanyl IN.
How should opioid-induced respiratory depression be managed?
As per CPG A0722 Opioid Toxicity.
What condition does procedural pain refer to?
A situation where short-term supplemental analgesia is required.
When can ketamine be used without an opioid?
If the patient is opioid-tolerant or allergic to opioids.
Are emergence reactions common with ketamine?
No, especially in low analgesic doses.
How can ketamine emergence reactions be minimised?
By slow IV administration and reassurance.
What if hypersalivation occurs with ketamine?
Usually managed with suction; consult AV Clinician for Atropine (MICA only) if severe.
Which medications require ongoing pain assessment and monitoring?
- Methoxyflurane
- Fentanyl
- Morphine
- Ketamine
What is the minimum monitoring interval?
Every 15 minutes.
What are the minimum observations for moderate-to-severe pain?
- Airway patency
- RR, SpO₂, HR, BP
- SAT score
