Opioid Range Orders: Essential to Safe Pain Management

Chris Pasero, MS, RN-BC


August 15, 2012

Clinical Presentation: Postoperative Pain in a Child

This patient is a 12-year-old girl with postoperative pain following an exploratory laparotomy and appendectomy 1.5 hours ago. She is admitted to the pediatric clinical unit after a 60-minute stay in the postanesthesia care unit (PACU).

The nurse who admits the patient to the clinical unit obtains the following information:

  • The patient is an otherwise healthy girl with a recorded weight of 90 lb and height of 5'1".

  • Vital signs:

    • Tympanic temperature: 98°F

    • Pulse: 80 beats/min

    • Respiration: 20 breaths/min, deep and regular; oxygen saturation on room air (using pulse oximetry), 98%

    • Blood pressure: 112/72 mm Hg

  • Skin is pink and warm.

  • Abdominal dressing is dry and intact.

  • The patient is awake and alert.

  • The patient transfers from stretcher to bed with minimal assistance, but grimaces and says "ouch, ouch" when she moves.

  • The patient points to her abdominal incision and describes the incision and area around it as "very sore, stings, and hurts a lot." She rates the intensity of pain as 7 using the 0-to-10 Faces Pain Rating Scale-Revised (FPS-R). She is trying to hold back tears and looks distressed.

  • The patient's comfort-function goal, established preoperatively, is 2 out of 10 (FPS-R) to ambulate with ease.

  • Her mother, father, and older sister are present.

Postoperative Pain

Postoperative pain management orders:

  • Acetaminophen 650 mg intravenously (IV) every 6 hours for 2 doses (first dose preoperatively), then switch to oral acetaminophen 650 mg every 6 hours if able to tolerate fluids. Notify the surgeon if unable to tolerate fluids.

  • Ketorolac 7.5 mg IV every 6 hours.

  • Morphine 1-4 mg IV every 2 hours as needed for pain.

  • Warm water-circulating pad to abdomen.

Analgesics administered in preoperative holding area and in the PACU:

  • First dose of IV acetaminophen 650 mg was given preoperatively.

  • Ketorolac 7.5 mg IV was given on admission to the PACU.

  • Fentanyl 25 μg IV was given on admission, and an identical dose was given 10 minutes later to reduce pain rating from 10 to 4 (FPS-R). Last dose was given 20 minutes before discharge from the PACU.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.