Fentanyl + Ketamine

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Protocol for the use of Fentanyl + Intravenous PCA / NCA Ketamine Use in conjunction with Pain Management Chart and Clinical Practice Guidelines Special Fentanyl is an alternative opioid, which may be used for patients who have a precautions contra-indication to morphine 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 ordered 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 infusion 2. Follow 3. Give Naloxone 4. Call Pain Control Service 5. Document actions in the child’s CEWS as prescribed records protocol The Pain Control Service can be contacted on Bleep 0577 at any time (24 hours) Intravenous weight drug and dose concentration 1 ml = 0.5 microgram/kg up to 50 kg Fentanyl 25 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 0.5 to 2 0 or 0.2 0.5 or 1 5 or 10 NCA standard 0.5 to 2 0, 0.2, 0.5 or 1 0.5 or 1 20 or 30 NCA in ICU areas 0.5 to 2 0, 0.2, 0.5 or 1 0.5 or 1 5 neonates & NCA 0.5 to 2 0 0.5 20 infants < 5 kg weight drug and dose concentration over 50 kg Fentanyl 1250 microgram 1 ml = 25 microgram made up to 50 ml with (Max 4 hrly dose: 20 mls) AND 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 0.5 to 2 0 1 or 2 5 or 10 NCA standard 0.5 to 2 0, 0.2, 0.5 or 1 1 20 or 30 NCA in ICU areas 0.5 to 2 0, 0.2, 0.5 or 1 1 5 DTC Approved Nov 2013 .

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