DOCUMENT CONTROL PAGE Title: Analgesia Guidelines for Infants Undergoing Title Version: 3 Reference Number: Supersedes Supersedes: Version 2 Significant Changes: Inclusion of algorithm Originator or modifier Ratification Originated By: (1) Dr. R Perkins (2) Dr. D Lord (3) Dr. D Fines (4) Denise Jonas (5) Annette Adams Designation: (1-3) Consultant Paediatric Anaesthetist (4) Lecturer/Practitioner (5) Principal Pharmacist Modified by: (1) Dr. R Perkins (2) Dr. D Fines (3) Dr. M Abdelrahman (4) Dorothy Lowthian (5) Adam Sutherland Designation: 1-3) Consultant Paediatric Anaesthetists (4) Lead Practitioner Children s Pain Team (5) Senior Clinical Pharmacist Referred for approval by: Children s Medicines Management Committee Date of Referral: January 2011 Application Patients Children only Circulation Review Issue Date: January 2011 Circulated by: Children s Pain Team Dissemination to (for Implementation): All Departments and all Medical staff Review Date: January 2013 Responsibility of: Children s Pain Team RMCH Paediatric Pain Team Policy Page 1 of 5
Date placed on the Intranet: February 2011 Please enter your EqIA Registration Number here: 135/10 Refer to section 5: Equality, Diversity and Human Rights Impact Assessment Section Contents Page 1 Detail of Procedural Documents - Analgesia Guidelines for Infants Undergoing Cleft Palate 3 Surgery 2 Equality, Diversity and Human Rights Impact 4 Assessment 3 Consultation, Approval and Ratification Process 4 4 References and Bibliography 4 RMCH Paediatric Pain Team Policy Page 2 of 5
1 Analgesia Guidelines for Infants Undergoing 1.1 Intra-operative Drugs Remifentanil Morphine Dexamethasone Drug doses will depend on age of infant and airway stability. Intra-operative analgesia remains the responsibility of the consultant anaesthetist. See BNF for Children OR Suggested Drug doses in the Red Pain Manual or visit the Paediatric Pain Team website on the Trust Intranet. Prior to leaving the recovery unit all infants should have appropriate analgesia with long acting agents such as morphine. Post operative oxygen will be prescribed according to the infant s individual need. 1.2 Postoperative First line analgesia should be REGULAR IV Paracetamol (6hourly) for the first 24 hours post operatively and Ibuprofen (6hourly as required). Oral Paracetamol should only be introduced after 24 hours. To assess the child s pain the FLACC pain assessment tool should be used, if pain score is 6 or above then oral morphine should be administered. The suggested doses of morphine must be adhered to as infants undergoing cleft lip and palate surgery are more susceptible to the adverse effects of morphine. IV Paracetamol Dose Maximum daily dose Under 10 kg 7.5 mg/kg 6 hourly 30 mg/kg/day Over 10 kg and under 50 15 mg/kg 6 hourly 60 mg/kg/day kg Over 50 kgs 1gram 6 hourly 4grams/day Oral Paracetamol Dose Maximum daily dose Under 3 months 15 mg/kg 6 hourly 60mg/kg/day Over 3 months 20 mg/kg 6 hourly 90 mg/kg/day Ibuprofen 5mg/kg 6 hourly To be prescribed for infants over 1 month of age. If required below this age group discuss with consultant anaesthetist Oral Morphine must be prescribed by a Consultant Anaesthetist only If there is any doubt or you feel analgesia is insufficient then please contact the consultant anaesthetist who anaesthetised the child. Oral Morphine Infants less than 6 months Infants over 6 months Dose 100 micrograms/kg 4 hourly Up to 200 micrograms/kg 4 hourly 1.3 Monitoring All infants under one year of age must have continuous Pulse Oximetry, apnoea alarms and ECG monitors. Children over one year of age must have pulse oximetry. All children must have IV access maintained. 2. Equality, Diversity and Human Rights Impact Assessment. RMCH Paediatric Pain Team Policy Page 3 of 5
2.1 This guideline has had an initial assessment completed completed and a unique EqIA Registration Number assigned (see document control sheet). 3. Consultation, Approval and Ratification Process 3.1 Consultation Process, Consultation and Communication with Stakeholders Consultant Anaesthetists, Cleft Lip and Palate Nurse Specialists and Children s Pain Team. 3.2 Policy Approval Process Children s Medicines Management Committee 3.3 Ratification Process Children s Medicines Management Committee 4. References and Bibliography None. RMCH Paediatric Pain Team Policy Page 4 of 5
S Analgesia Guidelines for Infants Undergoing Cleft Palate Has analgesia been prescribed as per guidelines? Has analgesia been administered? Ensure analgesia prescribed as per guidelines Administer IV paracetamol as prescribed and review in one hour Administer Ibuprofen as prescribed and review in one hour Continue analgesia as prescribed and monitor and record effect Administer oramorph as prescribed and review in one hour Contact Pain Team or on call anaesthetist RMCH Paediatric Pain Team Policy Page 5 of 5