Score, found, titrate, monitor, wean — leading acute nociceptive pain management on the ward

Candidate brief

You are the paediatric registrar on the ward overnight. An eight-year-old boy, 26 kg, has just been admitted after emergency orthopaedic fixation of a displaced forearm fracture. He is opioid-naive, alert, drinking sips, and passing urine. He is in moderate pain (numeric score 6 of 10) that has not been controlled by as-needed paracetamol. The ward nurse asks you to build a complete multimodal analgesic plan and to set up the monitoring. A medical student suggests codeine for the breakthrough pain. ^[11]

You have ten minutes to: confirm the weight and score the pain; build the multimodal foundation up the WHO two-step ladder; state the morphine intravenous dose and the patient-controlled analgesia parameters; set up the sedation-score monitoring; and prepare to recognise and respond to opioid-induced respiratory depression. ^[8]