Routine analgesia is typically simple analgesia with the addition of opiate analgesia as required. Most analgesic regimens are built on the “pain ladder”. The below are doses for standard immediate release formulation1.
Simple analgesia
Paracetamol
1000mg quaque 4-6 hora, max 4g in 24 hours
For body weights under 50: 15mg/kg, not exceeding 60mg/kg or 3g
Ibuprofen
400mg 3-4 in die, max 2.4g in 24 hours
Celecoxib
Selective NSAIDs are as effective for the treatment of acute pain as their nonselective counterparts. Their primary benefit is in their minimal action against COX-1 and thus their more favourable side effect profile and reduced platelet effects. They are probably not better than ibuprofen unless COX-1 inhibition is likely to cause issues.
200mg once daily
up to 400mg may be given daily in 1 or 2 divided doses if required, max 400mg in 24 hours.
Opioids
Opiate analgesia requires different dosing based on route.
Weak opioids
Tramadol
50-100mg not more than quaque 4 hora, max ~400mg daily
Codeine
30-60mg quaque 4 hora as required, max 240mg in 24 hours
Sometimes 15mg is good enough
Strong opioids
Morphine
ORAL: 5-10mg quaque 4 hora, adjusted according to response
Doses up to 30mg are probably reasonable… It is recommended to specify brand when prescribing oral morphine.
IV: load 2-5mg (slowly); then quaque 4 hora adjusted according to response.
Reduce dose in the elderly. In the acute setting, a 10mL syringe can be made up to 1mg/mL and used for initial control of severe pain.
Oxycodone
ORAL: 5mg quaque 4-6 hora, adjusted according to response
Fentanyl
IV: load 1-2mcg/kg (25-100mcg); then 0.35-0.5mcg/kg (25-50mcg) quaque hora
Fentanyl use is probably best left in ED or for critically ill patients.
Further reading
- Schug SA, Palmer GM, Scott DA, Alcock M, Halliwell R, Mott J, editors. Acute pain management: scientific evidence. Fifth edition. Melbourne: Australian and New Zealand College of Anaesthetists; 2020.
- New Zealand Formulary
Footnotes
-
Unless otherwise specified, doses are for oral administration. ↩