Drug regimens for analgesia without a significantly depressed conscious state

If analgesia without a significantly depressed conscious state is appropriate (see Principles of analgesia without a significantly depressed conscious state), the following drug regimens may be used alone, or in combination.

Inhaled analgesics must only be used for analgesia without a significantly depressed conscious state by suitably trained and credentialed practitioners. For adults and children 5 years or older, use:

1 methoxyflurane via a self-administered device, inhaled intermittently to maintain adequate analgesia and sedation for the duration of the painful procedure¹. Full analgesic effect is expected after 5 to 8 inhalations. Do not exceed a dose of 6 mL in 24 hours procedural sedation and analgesia, without a significantly depressed conscious state methoxyflurane

OR

1 nitrous oxide 50% with oxygen 50% via a patient-triggered device, inhaled intermittently to maintain adequate analgesia and sedation for the duration of the painful procedure². Full analgesic effect is expected after 5 to 8 inhalations. procedural sedation and analgesia, without a significantly depressed conscious state nitrous oxide

Opioids must only be used for analgesia without a significantly depressed conscious state by suitably trained and credentialed practitioners. For adults and children 2 years or older, use:

1 fentanyl 50 micrograms/mL solution³ procedural sedation and analgesia, without a significantly depressed conscious state fentanyl

spray up to 100 micrograms (child 2 years or older: 1.5 micrograms/kg up to 100 micrograms) intranasally, via atomiser attached to a small syringe. Spray up to 0.3 mL (15 micrograms) into each nostril, alternating between nostrils up to the required dose⁴. After 5 minutes, give a single repeat dose of 50 micrograms (child 2 years or older: 0.75 micrograms/kg up to 50 micrograms) intranasally, if required. Use lower doses in older or frail patients, and in patients who have received opioids in the past 2 hours or are receiving concomitant sedatives⁵

OR

1 fentanyl 50 micrograms (child 2 years or older: 0.5 micrograms/kg up to 25 micrograms) intravenously. After 5 minutes, give a single repeat dose of 25 micrograms (child 2 years or older: 0.25 micrograms/kg up to 10 micrograms) intravenously, if required. Use lower doses in older or frail patients, and in patients who have received opioids in the past 2 hours or are receiving concomitant sedatives⁵ fentanyl

OR

1 morphine 5 mg (child 2 years or older: 50 micrograms/kg up to 2.5 mg) intravenously. After 5 minutes, give a single repeat dose of 2.5 mg (child 2 years or older: 25 micrograms/kg up to 1 mg) intravenously, if required. Use lower doses in older or frail patients, and in patients who have received opioids in the past 2 hours or are receiving concomitant sedatives⁵. procedural sedation and analgesia, without a significantly depressed conscious state morphine

In adults, consider oxycodone as an alternative to fentanyl or morphine. Use:

oxycodone 5 mg intravenously. After 5 minutes, give a single repeat dose of 2.5 mg intravenously, if required. Use lower doses in older or frail patients, and in patients who have received opioids in the past 2 hours or are receiving concomitant sedatives. procedural sedation and analgesia, without a significantly depressed conscious state oxycodone

¹ Methoxyflurane must always be administered using the device supplied with the vials because they have a fitted charcoal filter, which minimises nonpatient exposure.Return

² The fixed-concentration preparation of nitrous oxide 50% with oxygen 50% is known as Entonox.Return

³ A 300 micrograms/mL solution is available in some hospitals; due to the smaller volume required, dividing the dose between nostrils may not be necessary.Return

⁴ The dose is divided into actuations because volumes over 0.3 mL are unlikely to be absorbed from the nasal mucosa; excess solution runs down the back of the throat limiting the effect due to poor gastrointestinal absorption of the swallowed portion. Return

⁵ For overweight children, use ideal body weight to calculate the dose.Return