These may be useful for older children. It can be difficult to assess pain in the pre-verbal or cognitively impaired child. Post-operative pain should always be measured at rest, not during movement or coughing. The prescription of an analgesic is determined by the assessment of pain severity. Mild pain is treated with non-opioids, moderate pain is treated with opioids such as codeine, and severe pain is treated with opioids such as morphine, fentanyl, pethidine, or methadone.
Oral analgesia is desirable in children whenever possible.
Standard doses and dosage intervals will provide excellent analgesia for the majority of patients. The intravenous route of administration provides rapid onset of analgesia with the advantage of incremental intravenous titration with no discomfort to the child. Intramuscular injections should be avoided as children will often deny having pain rather than have repeated intramuscular injections. For severe and ongoing pain, the regular administration of an appropriate analgesic will provide better efficacy than 'PRN' orders. Advanced regional anaesthetic techniques such as epidurals are the responsibility of the paediatric anaesthetist.