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Pain management - patients discharged from PICU on continuous infusion, PCA or Epidural

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General Points

  1. It is the responsibility of the discharging PICU registrar to ensure that all documentation relating to morphine infusion, PCA, or epidural is completed prior to patient discharge, particularly:
    1. Prescription form
      ensure that the usual weight based range of rate and bolus dose is prescribed

         Infusion range   Bolus range 
         Less than 3 months Greater than 3 months  Less than 3 months Greater than 3 months 
      Morphine IV infusion  0.5 -2 ml/hr 1-3 ml/hr   1 ml/15 minutes 1-2 ml/15 minutes 
      Fentanyl  IV infusion  0.5 -2 ml/hr  1-3ml/hr   0.5 - 2 ml/15 minutes 0.5 - 1ml/15 minutes
      Ketamine  IV infusion  Greater than 1 yr  1-4 ml /hr   NA
      Epidural/regional  infusion ≤ 0.2ml/kg/hr  ≤ 0.3ml/kg/hr     NA 
      PCA  Morphine  Greater than 6 yrs
       
      5-10 micrograms/kg/hr if required 
      10 - 20 micrograms /kg
      Lockout 5 -10 minutes 
      PCA  Fentanyl Greater than 6 yrs
      0.05 - 0.1 micrograms /kg/ hr if required  
      0.1 - 0.2 micrograms /kg
      Lockout 5 minutes  
    2.  Audit form
      ensure that date, weight and operation/pain complaint boxes are completed
  2. Patients who are admitted to PICU on one of these modalities will have had the pain service audit form placed in the pain service folder in PACU.
  3. Patients commenced on one of these modalities when in PICU will need an audit form completed and placed in the pain service folder in PACU when the appropriate pump is collected from PACU.
  4. The PICU long day registrar will contact the pain service registrar or pain nurse specialist via the phone numbers below and inform him/her of any discharges that need pain service follow up. This will be done by 1000 and if it hasn't occurred the pain registrar or pain nurse specialist should contact the PICU registrar.
  5. Any after hours discharges need to be directly referred to the pain service by the registrar discharging the patient.
  6. Any patient who is likely to have complex pain management issues, including opiate withdrawal, should be discussed directly with the pain service.

Important Numbers

Pain Service Registrar: Phone 021 938 273
Pain Service Nurse: Phone 021 492 509
PICU Registrar: Phone 021 893 885
To access the paediatric pain service after hours (Outside of Mon - Fri 0800 - 1700) contact the on call paediatric anaesthesia registrar on the above cell phone number.

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Document Control

  • Date last published: 07 June 2010
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Author(s): D Buckley
  • Editor: John Beca
  • Review frequency: 2 years