Which medications in the drug class Analgesics are used in the treatment of Pediatric Appendicitis?

Updated: Oct 25, 2018
  • Author: Adam C Alder, MD; Chief Editor: Carmen Cuffari, MD  more...
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Pain management is a contentious topic for some emergency physicians and surgeons. Several classes of analgesic medications have proven to be safe and efficacious in the preoperative pediatric patient.

It is ethical and prudent for emergency physicians, surgeons, anesthesiologists, pediatricians, and pharmacists to agree on a plan for providing pain relief to the pediatric patient. Topics to be agreed upon include type, route, dose, and frequency of administration of analgesic drugs.

Ketorolac (Toradol)

Ketorolac inhibits prostaglandin synthesis by decreasing the activity of cyclooxygenase, which results in decreased formation of prostaglandin precursors.

With proper dosing, it does not cause a significant decrease in hematocrit, increase in creatinine, or overall complications. Its use can decrease hospital stay and narcotic requirements in children who have undergone surgery.

Fentanyl citrate (Sublimaze)

Fentanyl is a synthetic opioid that is 75-200 times more potent and has a much shorter half-life than morphine sulfate. It has less hypotensive effects and is safer in patients with hyperactive airway disease than morphine because of minimal to no associated histamine release. By itself, it causes little cardiovascular compromise, although the addition of benzodiazepines or other sedatives may result in decreased cardiac output and blood pressure.

Consider continuous infusion of fentanyl because of its short half-life (30-60 min). Parenteral fentanyl is the drug of choice for conscious sedation analgesia. It is ideal for analgesia of short duration during anesthesia and the immediate postoperative period. It is readily titrated and is easily and quickly reversed by naloxone.

After the initial parenteral dose, subsequent parenteral doses should not be titrated more frequently than every 3 or 6 hours. Fentanyl is highly lipophilic and protein bound. Prolonged exposure leads to accumulation in fat and delays the weaning process.


Morphine sulfate has the advantages of reliable and predictable effects, a favorable safety profile, and ease of reversibility with naloxone. Various IV doses are used; it is commonly titrated until the desired effect is obtained.

The Joint Commission on the Accreditation of Healthcare Organizations has placed "MSO4" on the banned abbreviation list, because it can be mistaken for magnesium sulfate. Therefore, in writing the prescription, spell out "morphine sulfate" in full, legibly and clearly.

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