Table 1:

“The PMB Way Analgesia Protocols”

Background Analgesia and Sedation
	Drug	Paediatric	Adult
IV access/ICU/high care	Ketamine	1mg/kg IVI titrations quick onset quick offset	1mg/kg IVI titrations quick onset quick offset
Ward  Dose 1	Ketamine Midazolam	5mg/kg/per os 0.25mg/kg per os mixed together 20–30 mins to work	5mg/kg/per os 2.5 – 5 mg per os mixed together 20–30 mins to work
Ward  Dose 2 (for pain score > 3)	Ketamine NO Midazolam	half the previous dose ketamine IMI 5–10 mins onset	100mg ketamine IMI 5–10 mins onset
Ward  Dose 3 (for pain score > 3)	Ketamine NO Midazolam	half the previous dose ketamine IMI	100mg ketamine IMI
	The final total dose of Ketamine given at the procedure must be written as the script for the following dressing change, do not leave the inadequate dose as the prescription
Clinic	Ketamine OR Methoxyfluorane OR Morphine	5mg/kg IMI 0.5 mis inhaled -	5mg/kg IMI l-2mls inhaled 10–15mg lMI
Emergency Department	Ketamine Morphine Fentanyl	5mg/kg IMI - -	5mg/kg IMI 0.05mg/kg IVI 50 – 100mcg IVI
Background Analgesia and Sedation
	Drug	Paediatric	Adult
	these are oral doses unless otherwise stated
Mandatory	Paracetamol (syrup = 120mg/5ml)	15 mg/kg 6hrly	1g 6 hrly
Mandatory	Tilidine (1 drop = 2.5 mg)	1 mg/kg 6 hrly	-
Mandatory	Tramadol	-	50 – 100mg 6hrly
Add if pain not controlled and for donor site pain	Ibuprofen (100mg/5mls)	10mg/kg 8 hrly	400mg 8hrly
	Consider contraindications: Curling’s ulcer, acute kidney injury, comorbidities
Background Analgesia and Sedation
	Drug	Paediatric	Adult
Consider if >15%TBSA/pain still uncontrolled	Morphine syrup Img/ml	Start at 0.2 mg/kg 6 hrly Increase frequency up to 2 hrly then increase dose by 25%, consider infusion	0.2 mg/kg 6 hrly Increase frequency up to 2 hrly then increase dose by 25%, consider infusion
Add if pain not controlled OR neuropathic pain	Clonidine (25mcg tablets that cannot be broken)	25mcg 8 hrly increase to maximum 50mcg 8 hrly	75mcg 8hrly increase in increments of 25mcg per dose up to 150mcg 8hrly
Add if pain at night/difficulty sleeping	Amitryptiline	-	25mg nocte, can be increased to 50 and then 75mg nocte
For neuropathic pain and or severe itch	Pregabalin 75 or 150mg tabs mixed into suspension for paeds	start at 25mg 12hrly, increase in 25mg increments to max 75mg 12 hrly	start at 75mg 12 hrly, increase to max 150mg 12hrly
	Gabapentin 100 mg or 300 mg tablest	10mg/kg 8hrly, increments of 100mg/dose up to 600mg 8 hrly	300mg 8 hrly, increase up to 600mg 8 hrly
Add if neuropathic pain and no gabapen-tin/pregablin	Tegretol 200mg tabs	-	200mg 12 hrly increase to max 1200mg/day (400mg 8 hrly)
If itch and no pregaba/gabapentin	Allergex	0.1mg/kg start 12hrly, can be increased to 8 hrly	4mg 8 hrly
	Pyridoxine	-	25mg daily
For ICU patients/large TBSA burns (MORPHINE mixed as a Img/ml solution ie. 10 mg in 10 mis or 50mg in 50 mis)	Morphine IVI Remember this needs to be weaned and not stopped suddenly! (wean the infusion rate then move to bolus dosing and increase the dose interval over time)	0.1mg/kg loading dose then 0.1mg/kg/hour infusion increase to effect, reload and increase rate by 0.05mg/kg	0.1mg/kg loading dose then 0.1mg/kg/hour infusion increase to effect, reload and increase rate by 0.05mg/kg
For PTSD OR anxiety OR opioid withdrawal	Valium	2.5 mg nocte, titrate to effect can be increased to 8 hrly	5 mg nocte, titrate to effect can be increased up to 5–1 Omg 4hrly
For Delirium	Haloperidol	-	2.5 – 5mg 8hrly