MAJOR BURNS> 15%
- IV morphine
- is the most widely used analgesia for burns.
- bolus administration dose: 0.1 mg/kg.
- IV morphine continuous infusion dose: <6months: 0-12.5ug/kg/hour,
- >6months: 0-25 ug/kg/hour.
- Paracetamol
- 15mg/kg QID.
- Low dose ketamine infusion
- improve analgesia if standard doses of morphine do not provide adequate analgesia for pain.
Transition to oral analgesia
- Oral analgesics are started 1-2 hours before infusion/PCA ceased up.
| Oral background | Oral breakthrough |
| MS Contin (suspension or tablets) l Starting dose 0.6 mg/kg/dose 12 hourly regularly (for opioid naive) l Consistent mechanism of delivery - avoids potential risk of over sedation when combined with other agents e.g dressing analgesia or sedating antihistamines | Oral morphine (syrup) l 0.2 mg/kg/dose 4 hourly PRN l Preferred if nasogastric tube is used for administration Or Oral oxycodone (syrup or 5mg capsules) l >1 year: 0.2mg/kg/dose 4 hourly PRN l < 1year:0.1 mg/kg/dose 4 hourly PRN l Preferred if no nasogastric tube used - more palatable |
MINOR BURNS <15%
- Paracetamol
- 15 mg/kg/does 6 hourly regularly (all children)
- For breakthrough analgesia
- Oxycodone:
- >1 year: 0.2 mg/kg/dose 4 hourly PRN, <1 year: 0.1 mg/kg/dose 4 hourly PRN
- Ibuprofen:
- 10 mg/kg/dose 6-8 hourly PRN (cease 48 hours prior to surgery/grafting). Not to routinely prescribe for children <3 months
- Tramadol:
- 1-2 mg/kg 6 hourly PRN
- For more extensive burns/adequate analgesia:
- Morphine infusion or PCA with oral analgesia
- MS Contin:
- 0.6 mg/kg/dose 12 hourly can be used to maintain comfort and facilitates in regular face care
References:
- Guidelines for the Management of Paediatric Burns, Women’s and Children’s Hospital, 2010.
- Gandhi, M., Thomson, C., Lord, D., & Enoch, S. (2010). Management of pain in children with burns. International journal of pediatrics, 2010.
- Krishnamoorthy, V., Ramaiah, R., & Bhananker, S. M. (2012). Pediatric burn injuries. International journal of critical illness and injury science, 2(3), 128.
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