Recommended IV Pain Medications for Pediatric Patients
For pediatric patients requiring IV pain management, systemic opioids, particularly morphine or fentanyl, are recommended as first-line medications for moderate to severe pain, with IV acetaminophen and NSAIDs serving as important adjuncts. 1
First-Line IV Pain Medications
Opioid Analgesics
- IV morphine (0.1 mg/kg) is the standard first-line opioid for moderate to severe pain in pediatric patients 1
- IV fentanyl (1-2 μg/kg) is an excellent alternative, particularly when rapid pain relief is needed or in hemodynamically unstable patients 1
- Small, titrated doses of opioids can be safely used without masking symptoms or clouding mental status, even in cases of abdominal pain or multisystem trauma 1
Non-Opioid Analgesics
- IV acetaminophen (15 mg/kg) can be used as an adjunct to opioids for multimodal analgesia 2, 3
- IV NSAIDs (e.g., ketorolac) can be used judiciously as adjunctive therapy, though potential antiplatelet activity, GI, and renal toxicity should be considered 1
Route of Administration Considerations
- The IV route is preferred over intramuscular administration as it allows for rapid pain relief and medication titration 1
- Intramuscular injections should be avoided as they do not allow for titration and cause additional pain 1
- If IV access is challenging, consider alternative routes such as intranasal or transmucosal administration 1
Age-Specific Considerations
- For neonates and infants: Lower doses of morphine may be appropriate, but they can still safely receive opioid medications with proper monitoring 4
- For older children: Standard weight-based dosing of morphine (0.1 mg/kg) or fentanyl (1-2 μg/kg) is appropriate 1
Procedural Pain Management
- For painful procedures, consider adding sedative-hypnotic medications to analgesics 1
- Short-acting medications like propofol, alone or in combination with ketamine, are increasingly used for procedural sedation 1
- For minor procedures, consider nitrous oxide as an option when available 1
Multimodal Approach
- Combine IV opioids with non-opioid analgesics (acetaminophen, NSAIDs) for enhanced pain control and opioid-sparing effects 1
- Consider adjunctive medications like low-dose naloxone infusion (1 μg/kg/h) to reduce opioid side effects in patients receiving continuous opioid infusions 5
Special Considerations
- For patients with sickle cell vaso-occlusive crisis, IV morphine remains the mainstay of treatment, with IV acetaminophen and ketorolac as adjuncts 2, 3
- For extremity injuries, oral transmucosal fentanyl citrate (10-15 μg/kg) may provide comparable or better analgesia than IV morphine in situations where IV access is challenging 6
Common Pitfalls to Avoid
- Undertreatment of pain due to unfounded concerns about masking symptoms or respiratory depression 1
- Delayed administration of pain medications while awaiting diagnostic tests 1
- Failure to reassess pain and titrate medications accordingly 1
- Not providing clear discharge instructions regarding pain management 1