Pain Management in Children: Part 2 — A Transition from Codeine to Morphine for Moderate to Severe Pain in Children

Wong, Cecile; Lau, Esther; Palozzi, Lori; Campbell, Fiona

doi:10.3821/145.6.cpj276

Cited by 27 publications

(19 citation statements)

References 24 publications

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“…Thus, codeine is no longer an option and should be removed from the pediatric hospital's formulary, as is the case in most pediatric EDs in Canada [3,46]. Oral morphine is suggested to replace codeine.…”

Section: Oral Opioid Analgesics For Non-responders or For Moderate Painmentioning

confidence: 96%

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Managing Pediatric Pain in the Emergency Department

Bailey

Trottier

2016

Pediatr Drugs

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Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.

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Section: Oral Opioid Analgesics For Non-responders or For Moderate Painmentioning

confidence: 96%

“…Oral morphine is suggested to replace codeine. Physicians are very familiar with morphine, albeit via intravenous administration [46]. However, studies using oral morphine to treat acute pain in children are scarce.…”

Section: Oral Opioid Analgesics For Non-responders or For Moderate Painmentioning

confidence: 99%

Managing Pediatric Pain in the Emergency Department

Bailey

Trottier

2016

Pediatr Drugs

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“…At one of our institutions, codeine is no longer available for children and has been replaced by dihydrocodeine in the formulary. It has also been abandoned at the Hospital for Sick Children in Toronto, where it has been replaced by oral morphine [44].…”

Section: Use Of Codeine In Childrenmentioning

confidence: 99%

Codeine in mothers and children: where are we now?

Palanisamy

Bailey

2014

Anaesthesia

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“…La morphine a ainsi remplacé la codéine dans plusieurs protocoles postopératoires pédiatriques. En 2012, l'Hospital for Sick Children de Toronto a retiré la codéine de sa pratique après la parution d'une étude concluant au manque d'efficacité de cette molécule 4 . Une étude publiée par ce même hôpital en 2015 montre que la morphine administrée à des enfants souffrant d'apnée du sommeil diminue davantage le taux de saturation d'oxygène sanguin postopératoires que l'ibuprofène, ce qui a mené à une remise en question des pratiques 5,6 .…”

Section: Introductionunclassified