Basic principles of prescribing oral analgesics

Paracetamol is a commonly used mild analgesic and antipyretic and is rapidly absorbed orally.

It should be prescribed regularly six-hourly for ongoing pain. Intravenous paracetamol should only be prescribed if a child cannot tolerate oral intake.

Follow the PANDA guidance for the recommended doses for prescribing: Oral analgesic dosing guidelines for children

Please note: PR paracetamol is very poorly absorbed and is expensive. Its use is not recommended.

NSAIDs are very effective for treating pain, particularly pain originating from bone or muscle. The Trauma Service has agreed that children can receive NSAIDs for the duration of their admission. NSAIDs that have suitable preparations for children include ibuprofen and diclofenac. Regular administration is better than PRN. Giving NSAIDs and paracetamol together will enhance pain relief.

Follow the PANDA guidance for the recommended doses for prescribing:  Oral analgesic dosing guidelines for children

Side-effects include bronchospasm, excessive bleeding and renal impairment. The latter two are rarely seen with short-term use in well-hydrated children. Asthma is not necessarily a contraindication for their use; provided an asthmatic child has been symptom-free for the preceding month, and is not actively wheezy, they can be used cautiously. However, if wheezing does occur, stop further administration.

Diclofenac can be administered PR if a child cannot tolerate oral intake. The suppositories are available as 12.5 mg, 25 mg and 50 mg. Prescribe one of these suppository doses as close to 1 mg/kg with a dosing interval (8 to 12 hourly) to administer up to a total of 3 mg/kg a day (maximum 150 mg/day). Do not cut the suppositories as the drug may not be evenly distributed.

Intravenous NSAIDS should only be used in exceptional circumstances and after taking advice from the Pain Team.

An 'At a glance' document about the usage of IV NSAIDs as post-op analgesia in children is available on the Trust Intranet

Oramorph is an oral preparation of liquid morphine and can be effectively used in children who require more potent analgesics and are able to take oral fluids. This should be possible in most children where gastrointestinal function has not been disturbed.

The bioavailability is between 15-64% (mean 38%), consequently only approximately one third of the oral dose given will be absorbed.

N.B. Codeine Phosphate is no longer used for children in the OUHFT.

An 'At a glance' document about the usage of opioids in children is available on the Trust Intranet.

Follow the PANDA guidance for the recommended doses for prescribing:   Oral analgesic dosing guidelines for children