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M o rp h ine is th e treatm ent o f ch o ice fo r m o d erate to severe p ain. D evelo p m ent o f
to lerance is co m m o n in burn p atients and requires d o se augm entatio n.
A d juvant treatm ent m ay co m p lem ent analgesic m ed icatio n ( e.g. m assage th erap y ,
p sy cho therap y ).
Continuous pain (exp erienced at rest)
– M o d erate p ain:
paracetamol P O : 6 0 m g/ k g/ d ay in 4 d ivid ed d o ses
+ tramadol P O : 4 to 8 m g/ k g/ d ay in 4 d ivid ed d o ses
– M o d erate to severe p ain:
paracetamol P O : 6 0 m g/ k g/ d ay in 4 d ivid ed d o ses
+ slow release morphine P O : 1 to 2 m g/ k g/ d ay in 2 d ivid ed d o ses at 1 2 ho ur-interval. In
p atients with severe burns, o ral d rugs are p o o rly abso rbed in the d igestive tract d uring
the first 4 8 ho urs. M o rp hine m ust be ad m inistered by S C ro ute: 0 .2 m g/ k g every 4
ho urs.
Acute pain experienced during care
A nalgesics are given in ad d itio n to tho se given fo r co ntinuo us p ain.
– S ignificant m ed ical interventio ns and extensive burns: general anaesth esia in an
o p erating ro o m .
– L im ited no n-surgical interventio ns (d ressings, p ainful p hy sio therap y ):
• Mcodiledinteo PmOo :d0er.a6temp ga/ink, g6 0o rtotr9am0admolinPuOtes:b2efmo reg/gkivigngracraelrye:allo w s treatm ent to be
co m p leted co m fo rtably . I n the event o f treatm ent failure, use m o rp hine.
• MimmoeddeiartaetereolerasseevmeorerpphinaeinP, 6O0 :tionit9ia0l dmo sineuotefs0b.e5fotore1givmingg/ckarge.:T he effective d o se is
usually aro und 1 m g/ k g, but there is no m axim um d o se.
o r morphine S C : initial d o se o f 0 .2 to 0 .5 m g/ k g. T he effective d o se is usually aro und
0 .5 m g/ k g, but there is no m axim um d o se.
Note: d o ses given are fo r ad ults.
F o r p aracetam o l, d o sing is the sam e in child ren.
F o r tram ad o l and co d eine, d o sing is the sam e in child ren > 6 m o nths.
F o r m o rp hine, d o sing is the sam e in child ren > 1 y ear, sho uld be halved in child ren less
than 1 y ear, and quartered in infants less than 3 m o nths.
– P ain m anagem ent using m o rp hine d uring d ressing changes at the bed sid e requires:
• A trained nursing team .
•A
•C vailability o f im m ed iate release o ral m o rp hine and2nalo xo ne. 15 m in fo r the first
lo se m o nito ring: level o f co nscio usness, RR, p ulse, S aO , every
ho ur fo llo wing d ressing change, then ro utine m o nito ring.
• A ssessm ent o f p ain intensity and sed atio n d uring the interventio n and fo r 1 ho ur
thereafter.
• N ecessary equip m ent fo r ventilatio n by m ask and m anual suctio n.
• G entle hand ling o f the p atient at all tim es.
– A d justm ent o f m o rp hine d o ses fo r subsequent d ressings:
• If p ain intensity (S V S ) is 0 o r 1 : co ntinue with the sam e d o se.
• If S V S sco re ≥ 2 : increase the d o se by 2 5 to 5 0 % . I f p ain co ntro l rem ains inad equate,
the d ressing change sho uld be carried o ut in the o p erating ro o m und er anaesthesia.
– T ak e ad vantage o f the resid ual analgesia fo llo wing d ressing changes to carry o ut
p hy sio therap y .
– A s a last reso rt (m o rp hine unavailable and no facilities to give general anaesthesia),
kinetaamsianfee IsMettinagt (atnraailngeedsicstdaoff,sreessu(0sc.5itattoio 1n emqugip/ kmg)enret,inrfeocrocveesrtyheroaonamlg)e,saicdedffinegct o f the
p aracetam o l + tram ad o l co m binatio n given befo re a d ressing change.
272
M o rp h ine is th e treatm ent o f ch o ice fo r m o d erate to severe p ain. D evelo p m ent o f
to lerance is co m m o n in burn p atients and requires d o se augm entatio n.
A d juvant treatm ent m ay co m p lem ent analgesic m ed icatio n ( e.g. m assage th erap y ,
p sy cho therap y ).
Continuous pain (exp erienced at rest)
– M o d erate p ain:
paracetamol P O : 6 0 m g/ k g/ d ay in 4 d ivid ed d o ses
+ tramadol P O : 4 to 8 m g/ k g/ d ay in 4 d ivid ed d o ses
– M o d erate to severe p ain:
paracetamol P O : 6 0 m g/ k g/ d ay in 4 d ivid ed d o ses
+ slow release morphine P O : 1 to 2 m g/ k g/ d ay in 2 d ivid ed d o ses at 1 2 ho ur-interval. In
p atients with severe burns, o ral d rugs are p o o rly abso rbed in the d igestive tract d uring
the first 4 8 ho urs. M o rp hine m ust be ad m inistered by S C ro ute: 0 .2 m g/ k g every 4
ho urs.
Acute pain experienced during care
A nalgesics are given in ad d itio n to tho se given fo r co ntinuo us p ain.
– S ignificant m ed ical interventio ns and extensive burns: general anaesth esia in an
o p erating ro o m .
– L im ited no n-surgical interventio ns (d ressings, p ainful p hy sio therap y ):
• Mcodiledinteo PmOo :d0er.a6temp ga/ink, g6 0o rtotr9am0admolinPuOtes:b2efmo reg/gkivigngracraelrye:allo w s treatm ent to be
co m p leted co m fo rtably . I n the event o f treatm ent failure, use m o rp hine.
• MimmoeddeiartaetereolerasseevmeorerpphinaeinP, 6O0 :tionit9ia0l dmo sineuotefs0b.e5fotore1givmingg/ckarge.:T he effective d o se is
usually aro und 1 m g/ k g, but there is no m axim um d o se.
o r morphine S C : initial d o se o f 0 .2 to 0 .5 m g/ k g. T he effective d o se is usually aro und
0 .5 m g/ k g, but there is no m axim um d o se.
Note: d o ses given are fo r ad ults.
F o r p aracetam o l, d o sing is the sam e in child ren.
F o r tram ad o l and co d eine, d o sing is the sam e in child ren > 6 m o nths.
F o r m o rp hine, d o sing is the sam e in child ren > 1 y ear, sho uld be halved in child ren less
than 1 y ear, and quartered in infants less than 3 m o nths.
– P ain m anagem ent using m o rp hine d uring d ressing changes at the bed sid e requires:
• A trained nursing team .
•A
•C vailability o f im m ed iate release o ral m o rp hine and2nalo xo ne. 15 m in fo r the first
lo se m o nito ring: level o f co nscio usness, RR, p ulse, S aO , every
ho ur fo llo wing d ressing change, then ro utine m o nito ring.
• A ssessm ent o f p ain intensity and sed atio n d uring the interventio n and fo r 1 ho ur
thereafter.
• N ecessary equip m ent fo r ventilatio n by m ask and m anual suctio n.
• G entle hand ling o f the p atient at all tim es.
– A d justm ent o f m o rp hine d o ses fo r subsequent d ressings:
• If p ain intensity (S V S ) is 0 o r 1 : co ntinue with the sam e d o se.
• If S V S sco re ≥ 2 : increase the d o se by 2 5 to 5 0 % . I f p ain co ntro l rem ains inad equate,
the d ressing change sho uld be carried o ut in the o p erating ro o m und er anaesthesia.
– T ak e ad vantage o f the resid ual analgesia fo llo wing d ressing changes to carry o ut
p hy sio therap y .
– A s a last reso rt (m o rp hine unavailable and no facilities to give general anaesthesia),
kinetaamsianfee IsMettinagt (atnraailngeedsicstdaoff,sreessu(0sc.5itattoio 1n emqugip/ kmg)enret,inrfeocrocveesrtyheroaonamlg)e,saicdedffinegct o f the
p aracetam o l + tram ad o l co m binatio n given befo re a d ressing change.
272
