Module 6: Pediatric Trauma Analgesia and Sedation

Slide 1 - Learning ObjectivesSlide 2 - Evaluation of Pediatric PainSlide 3 - Anxiolysis: Non-pharmacologic StrategiesSlide 4 - Anxiolysis: Commonly Used MedicationsSlide 5 - Analgesia: Non-Pharmacologic StrategiesSlide 6 - Analgesia: Non-sedating MedicationsSlide 7 - Analgesia: Sedating MedicationsSlide 8 - Regional Analgesia in TraumaSlide 9 - Regional Analgesia: Peripheral Nerve BlocksSlide 10 - Regional Analgesia: Neuraxial BlocksSlide 11 - Patient-controlled Analgesia (PCA)Slide 12 - Sedation: OverviewSlide 13 - Sedation: PreparationSlide 14 - Sedation: PreparationSlide 15 - Sedation: Commonly Used MedicationsSlide 16 - Prepare Child for ProceduresSlide 17 - Practice CasesSlide 18 - Acknowledgments of 18

Analgesia: Sedating Medications

Medication	Class	Most common uses	Dosage	Duration	Pros	Cons
Morphine	Opioid	Acute severe pain, long acting	PO: 0.2-0.5 mg/kg IV: 0.05-0.15 mg/kg	3-5 h	Good analgesia for severe pain expected to last hours	Nausea, vomiting, pruritis, respiratory depression, accumulation in renal dysfunction
Hydromorphone (Dilaudid)	Opioid	Acute severe pain, long acting	IV: 0.01-0.02 mg/kg	3-4 h	Good analgesia for severe pain expected to last hours	Respiratory depression
Fentanyl	Opioid	Acute severe pain, short acting	IN: 1-2 MCG/kg IV: 1-2 MCG/kg	30-60 min	Rapid acting. Short duration. Good for treatment of self-limited pain or painful procedures.	Respiratory depression, short acting, accumulation with frequent repeat dosing
Oxycodone	Opioid	Moderate pain, long acting	PO: 0.1-0.2 mg/kg	3-6 h	Good analgesia for moderate ongoing pain	Respiratory depression, oral formulation only
Diazepam (Valium)	Benzodiazepine	Muscle spasm, whiplash	PO: 0.2 mg/kg IV: 0.1 mg/kg	6-8 h	Good for muscle spasm (ex. femur fracture) or neck pain from whiplash	Respiratory depression, especially when combined with opioids
Ketamine	NMDA antagonist	Sedation, infusion after surgery	IM: 0.5-1 mg/kg* IV: 0.5-1 mg/kg* IV ggt: 0.5 MCG/kg/ min	IM: 3-4 h* IV: 1-2 h*	Good for sedation for painful procedures or as an IV infusion after surgery with ongoing pain Relatively hemodynamically stable. Maintains airway tone	Tachycardia, increased secretions, dissociative effects
Dexmedetomidine (Precedex)	Alpha-2 agonist	Sedation, infusion during surgery, adjunct	IV: 0.5-1 mcg/kg IV ggt: 0.2-0.5 MCG/kg/h	1-2 h	Good for sedation for painful procedures or as opioid sparing adjunct. Reduces emergence delirium	Bradycardia, hypotension, sedation
Tizanidine	Alpha-2 agonist	Muscle spasm in children > 2yo	PO: 1-4 mg	3-6 h	Adjunct for spasm pain	Hypotension. Bradycardia. Sedation.
Gabapentin	Gabapentinoid, AED	Adjunct for ongoing or neuropathic pain	PO: 5 mg/kg	6-8 h	Good for subacute/ chronic neuropathic pain.	Sedation. Weak on its own. Slow acting. Withdrawal if abrupt discontinuation

Module 6: Pediatric Trauma Analgesia and Sedation

Analgesia: Non-sedating Medications

Regional Analgesia in Trauma