Page 280 Guide to Pain Management in Low-Resource Settings

268 Dilip Pawar and Lars Garten

Table 5 Table 6
Duration of action of caudal bupivacaine with adjuvants Dosage of epidural infusions
Drug Duration of Action (hours) Bupivacaine 0.1% with fentanyl 1–2 μg/mL
Bupivacaine 0.25% 4–6 Infants under 6 months 0.1 mL/kg/h
Bupivacaine 0.25% with ketamine 0.5 mg/kg 8–12 Children over 6 months 0.1–0.3 mL/kg/h
Bupivacaine 0.25% with clonidine 1–2 μg/kg 8–12
Bupivacaine 0.25% with tramadol 1.5 mg/kg 12
Bupivacaine 0.25% with morphine 30–50 μg/kg 12–24
Bupivacaine 0.25% with ketamine 0.5 mg/kg
and morphine 30 μg/kg 24

Table 7
Frequently used drugs and their dosage regimes
Drug Dosages and Regimens Dose According to Body Weight
Drug Dosage Form 3–6 kg 6–10 kg 10–15 kg 15– 20 kg 20– 29 kg
Paracetamol 10–15 mg/kg, up to 4 times a 100-mg tablet - 1 1 2 3
(acetaminophen) day
500-mg tablet - ¼ ¼ ½ ½
Ibuprofen 5–10 mg/kg orally 6–8 hourly 200-mg tablet - ¼ ¼ ½ ¾
to a maximum of 500 mg/day
400-mg tablet - - - ¼ ½
Codeine 0.5–1 mg/kg orally 6–12 hourly 15-mg tablet ¼ ¼ ½ 1 1½
Morphine Calculate EXACT dose based on weight of child!
Oral: 0.2–0.4 mg/kg 4–6 hourly; increase if necessary for severe pain.
Intramuscular: 0.1–0.2 mg/kg 4–6-hourly.
Intravenous bolus: 0.05–0.1 mg/kg 4–6-hourly (give slowly!).
Intravenous infusion: 0.005–0.01 mg/kg/hour (in neonates only 0.002–0.003!).
Ketamine 0.04 mg/kg/hr–0.15 mg/kg/hr i.v./s.c.
(titrated to eff ect: usually maximum 0.3 mg/kg/h–0.6 mg/kg/h)
OR 0.2 mg/kg/dose–0.4 mg/kg/dose orally t.i.d., q.i.d., and p.r.n.
Tramadol 1 mg/kg–2 mg/kg 4–6 hourly (max. of 8 mg/kg/day)
Adapted from: World Health Organization. Pocket book of hospital care for children—guidelines for the management of
common illness with limited resources. World Health Organization; 2005.

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