Oxycodone + Ketamine

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Protocol for the use of Oxycodone + Intravenous PCA / NCA Ketamine Use in conjunction with Pain Management Chart and Clinical Practice Guidelines Special Oxycodone is an alternative opioid, which may be used for patients who have a Precautions contra-indication to morphine and fentanyl or as part of an opioid rotation plan. Ketamine should only be prescribed after discussing the patient with an Anaesthetist or the Pain Control Service General instructions No supplementary opioids unless requested by the Anaesthetist or Pain Control Service Line for IV opioids should be exclusive or an anti-reflux valve must be used An anti-syphon line must be used outside ICUs Record observations according to Clinical Practice Guidelines (at least hourly) Assess for pain and potential opioid related side-effects hourly while on NCA/PCA, and for 6 hours after cessation Multi-modal / synergistic analgesia – ensure it is prescribed and administered Treatment of Nausea & vomiting: Give antiemetics as prescribed side-effects: Itching: Chlorphenamine as prescribed Over sedation: See Sedation Scale Respiratory depression: Assess child and if depression is suspected: 1. Stop 2. Follow CEWS 3. Give Naloxone 4. Call Pain Control 5. Document actions in the infusion protocol as prescribed Service child’s records The Pain Control Service can be contacted on Bleep 0577 at any time (24 hours) Intravenous weight drug and dose solution concentration Up to 50 kg Oxycodone 1 mg/kg 1 ml = 20 microgram/kg made up to 50 ml with AND (Max 4 hrly dose: 20 mls) 0.9% sodium chloride or 5% glucose Ketamine 1 or 2 mg/kg 1 ml = 20 or 40 microgram/kg SUGGESTED INITIAL Loading dose Background inf Bolus dose Lockout PROGRAM (ml) (ml/hr) (ml) (mins) PCA standard 2.5 or 5 0 or 0.2 0.5 or 1 5 or 10 NCA standard 2.5 or 5 0, 0.2, 0.5 or 1 0.5 or 1 20 or 30 NCA in ICU areas 2.5 or 5 0, 0.2, 0.5 or 1 0.5 or 1 5 neonates & NCA 1 or 2.5 0 0.5 20 infants < 5 kg weight drug and dose solution concentration Over 50 kg Oxycodone 50 mg 1 ml = 1 mg made up to 50 ml AND (Max 4 hrly dose: 20 mls) 0.9% sodium chloride or 5% glucose Ketamine 50 or 100 mg 1 ml = 1 or 2 mg SUGGESTED INITIAL Loading dose Background inf Bolus dose Lockout PROGRAM (ml) (ml/hr) (ml) (mins) PCA standard 2.5 or 5 0 1 or 2 5 or 10 NCA standard 2.5 or 5 0, 0.2, 0.5 or 1 1 20 or 30 NCA in ICU areas 2.5 or 5 0, 0.2, 0.5 or 1 1 5 DTC Approved Nov 2013 .

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Opioid-Induced Hyperalgesia in Humans Molecular Mechanisms and Clinical Considerations
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