PAIN GRID---Guidelines For Typical Acute
Pain in Opioid Naïve Patients)
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Adult
dosing in 50 to 100kg range |
Adults
<50kg and Children |
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1 Acetaminophen 325mg q4h |
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Acetaminophen 10mg/kg q4h |
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1 Aspirin 325mg
q4h |
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Aspirin 10mg/kg
q4h |
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Mild/Moderate (3)
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2 Acetaminophen 325mg q4h |
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Acetaminophen 15mg/kg q4h |
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2 Aspirin
325mg q4h |
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Aspirin 15mg/kg q4h |
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Moderate (4) |
IM/SQ |
IV |
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1 Vicodin q4h |
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MS 2mg q2h |
Vicodin/Lortab Elix. 0.2mg/kg q4h |
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2 Tylenol #3 q4h |
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Dilaudid 0.4mg q2h |
Tylenol w/Cod. Elix. 0.5mg/kg q4h |
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1 Darvocet N-100 q4h |
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Demerol 20mg q2h |
MS 0.04mg/kg q2h IV |
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1 Ultram 50mg q6h |
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Demerol 0.4 mg/kg q2h IV |
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Moderate/Severe (5)
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IM/SQ |
IV |
IM/SQ |
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IV |
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1 Percodan/Percocet q4h |
MS 6mg q3h |
MS 4mg q2h |
Ibuprofen 10mg/kg q6h for children |
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2 Vicodin q4h |
Dilaudid 1.2mg q3h |
Dilaudid 0.8mg q2h |
Vicodin/Lortab Elix. 0.4mg/kg q4h |
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2 Tylenol #3 q4h |
Demerol 50mg q3h |
Demerol 40mg q2h |
Tylenol w/Cod. 1mg/kg q4h |
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1 Naprosyn 500mg bid |
Toradol 30mg q6h* *>65yo use 15mg q6h |
Toradol 30mg q6h* *>65yo use 15mg q6h |
MS 0.08mg/kg q3h |
MS 0.05mg/kg q2h |
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2 Darvocet N-100=1300mg of Tylenol (Inadvisable) |
Dilaudid 0.016 mg/kg q3h |
Dilaudid 0.01 mg/kg q2h |
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Demerol 0.8mg/kg q3h |
Demerol 0.5mg/kg q2h |
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Severe (6-7) |
IM/SQ |
IV |
IM/SQ |
IV |
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2 Percodan/Percocet q4h |
MS 8mg q3h |
MS 5mg q2h |
MS 0.1mg/kg q3h |
MS 0.06mg/kg q2h |
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Roxanol Sol 20mg q4h |
Dilaudid 1.5mg q3h |
Dilaudid 1mg q2h |
Dilaudid 0.02mg/kg q3h |
Dilaudid 0.012mg/kg q2h |
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Dilaudid 4mg q4h |
Demerol 75mg q3h |
Demerol 50mg q2h |
Demerol 1mg/kg q3h |
Demerol 0.6mg/kg q2h |
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Levodromoran 2mg q6h |
Codeine 60mg q4h |
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Methadone 10mg q6-8h (d) |
Levodromoran 1mg q6h |
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Very Severe (8) |
IM/SQ |
IV |
IM/SQ |
IV |
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Roxanol/MS I.R. tab 30mg q4h |
MS 10mg q3h |
MS
6mg q2h
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MS 0.12mg/kg q3h |
MS 0.08mg/kg q2h |
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Dilaudid 8mg q4h |
Dilaudid 2mg q3h |
Dilaudid
1.2mg q2h
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Dilaudid 0.024mg/kg q3h |
Dilaudid 0.016mg/kg |
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Levodromoran 4mg q6h |
Demerol not recommended |
Demerol not recommended |
Demerol 1.2mg/kg q3h |
Demerol not recommended |
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Methadone Sol 20mg q6-8h |
Levodromoran 2mg q6 |
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Oxycodone IR 20mg q4h |
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Extremely Severe (9) |
IM/SQ |
IV |
IM/SQ |
IV |
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Roxanol Sol 35mg q4h |
MS
12mg q3h
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MS
8mg q2h
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MS 0.15mg/kg q3h |
MS 0.1mg/kg q2h |
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Dilaudid Oral Sol 12mg |
Dilaudid
2.4mg q3h
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Dilaudid
1.5mg q2h
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Dilaudid 0.03mg/kg q3h |
Dilaudid 0.02mg/kg q2h |
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Methadone Sol. 25mg q6-8h |
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Oxycodone Conc. 25mg q4h |
Demerol not recommended |
Demerol not recommended
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Demerol 1.5mg/kg q3h |
Demerol not recommended |
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Most Severe (10) Worst possib. |
IM/SQ |
IV |
IM/SQ |
IV |
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Roxanol Sol 45mg q4h |
MS
15mg 3qh
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MS
10mg q2h (e)
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MS 0.17mg/kg q3h |
MS 0.12mg/kg q2h |
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Dilaudid Oral Sol 15mg |
Dilaudid
3mg q3h
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Dilaudid
2mg q2h (e)
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Dilaudid 0.04mg/kg q3h |
Dilaudid 0.03mg/kg q2h |
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Methadone Sol 30mg q6-8h |
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Oxycodone Conc. 30mg q4h |
Demerol not recommended |
Demerol not recommended |
Demerol 1.7mg/kg q3h |
Demerol not recommended |
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(a)
Demerol not recommended except for short procedures where rapid
dissipation of effect is desirable or known
intolerance or
true allergic response to Dilaudid and Morphine exists. Demerol is contraindicated in renal dysfunction. (b)
Consider total acetaminophen content (max daily acetaminophen should
be 4000 mg). (c) For
pain level six (6) and above with frequency q2h or more often. Consider PCA
use. (d)
Methadone has a long ½ life – Reduce frequency after first 24 hours. (e)
Titrate over up to 2 hours in intermittent doses.