Subcutaneous opioid (Paediatric)

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1. The subcutaneous opioid algorithm may be used in the following areas:

  • Children’s ward
  • ITU, SHDU, Theatres and Recovery areas.

2. Morphine is the opioid of choice.

3. In the following children, CAUTION should be exercised and the opioid dose should be reduced:

  • Children with renal impairment
  • Children with liver failure
  • Children at risk of airway obstruction

The following children are NOT SUITABLE for the opioid algorithm:

  • Children with oedema or poor skin condition at the injection site
  • Children with poor peripheral circulation (altered drug absorption)
  • Children with head injuries
  • Children whose pain is of a chronic non-malignant nature.

4. All children should have patent intravenous access.

5. Nursing staff should be competent in the use of the opioid algorithm and have attended In-service training on its use.

6. All areas must have NALOXONE (0.4mg ampoule) immediately available.



Management of Subcutanaeous Cannula

Observation of the Child

Pulse, oxygen saturation levels, respiratory rate, pain score, sedation score and nausea score must be recorded on the observation chart as follows.

  • ½ hour after each administration of opioid
  • Minimum observations thereafter is hourly, but remember that the child’s condition may require these to be more frequent.
  • Stop the subcutaneous opioid algorithm when the child is established on oral or rectal analgesia.
Oxygen Saturations levels less than 94% on air with no other known cause
  1. Administer oxygen 4 litres/min by facemask and ensure a clear airway.
  2. Stay with the child and monitor respiratory rate, sedation and oxygen saturation levels continuously.
  3. Contact the ITU anaesthetist for further advice.
  4. Assess for other causes.
  5. Reduce subsequent dose of opioid by half and assess if the child's pain can be managed with paracetamol and/or NSAIDS (oral/rectal).


Editorial Information

Last reviewed: 11 June 2019

Next review: 11 June 2021

Author(s): Acute Pain Team

Version: 2

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Acute Pain Nurse Specialist

Document Id: TAM320