Management of Acute Pain in Children: Pharmacologic

Intravenous Opioids

With few exceptions, opioids should be administered to children either via the oral or intravenous route. Intramuscular injections should be avoided unless absolutely necessary. Many children have a tremendous fear of "shots" and if offered an injection for pain relief, will deny that they are in pain to avoid receiving a shot. Some children are willing to endure a great deal of pain if intramuscular injections are all that are offered for postoperative pain relief.

Though intermittent intravenous boluses of morphine, hydromorphone or fentanyl can provide rapid pain relief, their duration of action is short, resulting in marked fluctuations in serum opioid concentrations during the dosage period. The dosing interval for these opioids, therefore, should not be greater than every 2 to 4 hours. In order to provide a more steady analgesic effect, continuous opioid infusions and patient- or nurse- controlled analgesia (PCA or NCA) are commonly used to circumvent these fluctuations in plasma concentrations. Intermittent dosing with the longer-acting opioid, methadone, can also be very effective.