Analgesia for marine envenoming and penetrating marine injuries
If first aid with hot water immersion does not relieve pain from a marine envenoming or penetrating marine injury, use:
ibuprofen 200 to 400 mg (child 3 months or older: 8 to 10 mg/kg up to 400 mg) orally, every 8 hours up to a maximum of 2400 mg daily (child: 30 mg/kg up to 2400 mg) daily1 marine envenoming and penetrating marine injuries - analgesia ibuprofen
PLUS
paracetamol immediate-release 1 g (child: 15 mg/kg up to 1 g) orally, four times daily, with a minimum interval of 4 hours between doses. Maximum dose is 4 g (child: 60 mg/kg up to 4 g) in 24 hours. marine envenoming and penetrating marine injuries - analgesia paracetamol
If this is ineffective, add an oral opioid analgesic:
oxycodone immediate-release 2.5 to 10 mg (child: 0.1 to 0.2 mg/kg up to 5 mg) orally, every 4 hours. Use the lower end of the dose range for patients in a community setting, or elderly, cachectic or frail patients. marine envenoming and penetrating marine injuries - analgesia oxycodone
To determine the need for, and appropriateness of, repeat doses of opioids, monitor the patient’s pain intensity, sedation score and objective measures of respiratory function (eg oxygen saturation, respiratory rate).
If oral analgesia is inadequate for severe pain, use an intravenous opioid analgesic. The Analgesic guidelines give detailed advice on dosage and administration of intravenous opioid analgesia for acute pain in adults and children.