Disclaimer: This protocol is not intended for clinical application. Users are fully responsible for any use of this document.
Standard Hospital Formula
Morphine 2 mg/kg in 50 ml Dextrose 5% or 0.9% Saline 1 ml = 40 mcg/kg (weight-based target concentration for every patient) Max concentration: 100 mg/50 ml (prefilled adult cartridge >50 kg)
Pump Settings
Parameter
Setting
Notes
Loading dose
80–120 mcg/kg
By anaesthetist
PCA bolus
0.5 ml (20–40 mcg/kg)
1 mg if >50 kg
Lockout
6 minutes
Range 5–12 min
Continuous infusion
0.5 ml/hr (not in use currently)
Range 0–1 ml/hr (not in use currently)
Max dose limit
400 mcg/kg/4 hr (<50 kg)
20 mg/4 hr (>50 kg)
Instructions
IV Opioid Safety
No supplementary opioids unless prescribed by Anaesthetist
Use anti-siphon valve with all IV opioid infusions
Use a dedicated line or anti-reflux valve
Maintain IV access throughout
Monitoring
Observe hourly for 4 h, then 4-hourly
Record RR, HR, BP, Temp, Pain/Nausea/Sedation
If all scores zero twice → 6-hourly
Regular Analgesics
NSAIDs: Difene 1 mg/kg PR q12h or ibuprofen 7.5 mg/kg PO TID
RR < 8/min: Administer O2 and give Naloxone Naloxone – Resuscitation dosing (respiratory compromise)
• 1 month–11 years: 100 mcg/kg IV (max 400 mcg). If no response, repeat every 1 min to max 2 mg, then review.
• 12–17 years: 400 mcg IV, then 800 mcg for up to two additional doses at 1-min intervals to max 2 mg (up to 4 mg in seriously poisoned patients), then review.
• Continuous IV infusion (if repeated boluses needed): 5–20 mcg/kg/hour, titrate to response. Initial rate may be set to 60% of the effective resuscitative IV dose per hour (dose that maintained self-ventilation for ≥15 min).
Example: Effective dose = 800 mcg → start infusion at 480 mcg/hour. Notes: Short duration—monitor for rebound respiratory depression. Doctor administration only. Avoid in tramadol overdose (↑ seizure risk).
Patient Review
Review next day and at PCA stop by Anaesthetist (bleep 097). Record pain, sedation, nausea/vomiting scores, drug use, and patient/parent satisfaction in the PCA audit book.
Glossary
Loading dose
Clinician-given before PCA to establish relief
Bolus dose
Delivered when patient presses handset
Lockout
Minimum time between allowed boluses
Background infusion
Continuous infusion if prescribed
Total drug given
All bolus + background doses to date
Example Calculation
Baseline: 100 mg/50 ml prefilled
Target: 40 mcg/kg/ml
Bolus: 0.5 ml = 20 mcg/kg
Example (30 kg): needs 60 mg in 50 ml
From 100 mg in 50 ml → remove 20 ml (40 mg) and replace with 20 ml saline
