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Author: Admin | 2025-04-28
(b) Decide how many uses and over what timeframe you will be using the vial iii) Morphine (1) General (a) Slower onset (40 - 60 minutes) than oxymorphone but longer duration (12 - 18 hours) (i) Based on lower lipid solubility than oxymorphone and hydromorphone (2) Dose (a) 0.1 mg/kg (b) q.s. to 0.1 ml/kg to 0.2 ml/kg with saline (i) If volumes over 6 cc are used (some will use 0.2 ml/kg without limit) give slowly over 1 to 2 minutes (3) If preservative free Morphine is not available (a) Use a dedicated “Epidural” bottle (i) Label as “Epidural Use Only” and date vial (ii) Decide how many uses and over what timeframe you will be using the vial (b) Methylparaben is the preferred preservative (c) Formaldehyde containing morphine is not recommended iv) Oxymorphone (1) General (a) Faster onset (20 minutes) than morphine but shorter duration ( 8 to 12 hours) (i) Based on higher lipid solubility than morphine and hydromorphone (2) Dose (a) 0.10 mg/kg (b) q.s. to 0.1 ml/kg to 0.2 ml/kg with saline (i) If volumes over 6 cc are used (some will use 0.2 ml/kg without limit) give slowly over 1 to 2 minutes e) Local Anesthetic Agents i) General (1) Causes peripheral vasodilation via sympathetic blockade leading to some degree of hypotension (2) May still have motor effects the next day ii) Bupivacaine (1) General (a) 20 - 30 minute latent period before onset of surgical analgesia (b) Provides 4 -6 hours of surgical analgesia (2) Dose (a) 1.0 ml of 0.5 % solution / 5 kg (maximum dose) (i) Reduce by 1/2 when added to 0.1 mg/kg morphine for 0.2 ml/kg total dose (ii) Total volume should not exceed 0.2 ml/kg. Some cap volume at 6 ml. 1. Reduce bupivacaine dose accordingly when other agents are used (b) Sympathetic blockade can create hypotension (c) Great for perianal surgery iii) Lidocaine (1) General (a) Almost immediate effect - 5 minutes (b) Provides 60 - 90 minutes of surgical analgesia (2) Dose (a) 1.0 ml / 5 kg to maximum of 20 ml total dose
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