Good Practice in Postoperative and Procedural Pain Management ...

tein binding are reduced and the half-life is increased.These differences, which are dependent on gestationalage and birth weight, are mainly due to reducedmetabolism and immature renal function in the developingchild. This younger age group demonstrates anenhanced susceptibility to the effects, and the sideeffects of morphine and dosing schedules must bealtered to take this into account. Morphine has poororal bioavailability as it undergoes extensive first-passmetabolism in the liver and gut.Morphine dosing schedulesAn appropriate monitoring protocol should be useddependent on the route of administration and age ofthe child. For neuraxial dosing, see section 6.2.Oral:Neonate: 80 mcgÆkg )1 4–6 hourlyChild: 200–500 mcgÆkg )1 4 hourlyIntravenous or subcutaneous loading dose: (titratedaccording to response)Neonate: 25 mcgÆkg )1 incrementsChild: 50 mcgÆkg )1 incrementsIntravenous or subcutaneous infusion:10–40 mcgÆkg )1 Æh )1Patient-controlled analgesia (PCA):Bolus (demand) dose: 10–20 mcgÆkg )1Lockout interval: 5–10 minBackground infusion: 0–4 mcgÆkg )1 Æh )1Nurse controlled analgesia (NCA):Bolus (demand) dose: 10–20 mcgÆkg )1Lockout interval: 20–30 minBackground infusion: 0–20 mcgÆkg )1 Æh (1 year 100–200 mcgÆkg )1 4 hourlyIntravenous or subcutaneous loading dose: (titratedaccording to response)Neonate: 10–25 mcgÆkg )1 incrementsChild: 25–100 mcgÆkg )1 incrementsIntravenous or subcutaneous infusion:2.5–25 mcgÆkg )1 Æh )1Intranasal:100 mcgÆkg )1 in 0.2 ml sterile water instilled intoone nostril.HydromorphoneHydromorphone is an opioid analgesic related to morphinebut with a greater analgesic potency and is usedfor the relief of moderate-to-severe pain. It is a usefulalternative to morphine for subcutaneous use because itsgreater solubility in water allows a smaller dose volume.Hydromorphone dosing schedulesOral: 40–80 microg/kg 4 hourlyIntravenous or subcutaneous loading dose: (titratedaccording to response)Child