Oral morphine and respiratory function amongst hospice inpatients with advanced cancer
Female; Humans; Male; Analgesics; Aged; Middle Aged; Drug Monitoring; Health Services Research; Inpatients; Administration; Oral; Pain/drug therapy/etiology; Respiratory Function Tests; hospice care; Morphine/administration & dosage/adverse effects; Neoplasms/classification/complications/physiopathology; Opioid/administration & dosage/adverse effects; Respiratory Insufficiency/chemically induced/diagnosis
BACKGROUND: Respiratory depression is the opioid adverse effect feared most by physicians. This may hinder adequate dosing in cancer pain. The study was conducted to examine the respiratory function of patients with advanced cancer receiving significant doses (>100 mg/24 h) of oral morphine. PATIENTS AND METHODS: Consecutive pain-free hospice inpatients with advanced cancer receiving high-dose immediate-release oral morphine were evaluated. A single assessment of respiratory rate (RR), arterial blood gas (ABG), and peak flow rate (PFR) was made at assumed morphine steady state. Venous blood was drawn for a trough morphine plasma level. RESULTS: Of 31 patients who consented to examination, 20 completed the study assessment; 12 had chronic bronchitis. The median morphine dose was 30 mg 4-hourly (range 20 to 90 mg). Only one patient had evidence of ventilatory impairment. CONCLUSIONS: Morphine does not commonly cause chronic ventilatory impairment when given in this way in this population even in the presence of pre-existing or concurrent respiratory disease. Oral morphine given repeatedly in individualized dosage is a safe and efficacious analgesic in the majority of those with advanced cancer.
2003
Walsh TD; Rivera NI; Kaiko R
Supportive Care In Cancer : Official Journal Of The Multinational Association Of Supportive Care In Cancer
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1007/s00520-003-0530-0" target="_blank" rel="noreferrer">10.1007/s00520-003-0530-0</a>
Continuous subcutaneous infusion of morphine in children with cancer
Child; Adult; Preschool; infant; Infusions; Human; Palliative Care; Parenteral; Adolescence; Morphine/administration & dosage/adverse effects; Neoplasms/drug therapy
Seventeen children with severe pain due to malignant neoplasm were successfully treated with a subcutaneous infusion of morphine sulfate using a syringe pump. Pain relief was adequate in every case without major side effects. The median dosage required was 0.06 mg/kg/hr (range, 0.025 to 1.79 mg/kg/hr). Three patients received the subcutaneous infusion at home. No patient required an intravenous line for pain control.
1983
Miser AW; Davis DM; Hughes CS; Mulne AF; Miser JS
American Journal Of Diseases Of Children
1983
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Patient-controlled analgesia with low dose background infusions after lower abdominal surgery in children
Child; Female; Humans; Male; Pain; Analgesia; Drug Administration Schedule; Non-U.S. Gov't; Research Support; Comparative Study; Infusions; Intravenous; Nausea/chemically induced; Morphine/administration & dosage/adverse effects; Postoperative Period; Sleep/drug effects; Vomiting/chemically induced; Postoperative/drug therapy; Appendectomy; Patient-Controlled/adverse effects/methods
Forty-five children (aged 6-12 yr) undergoing appendicectomy received one of three analgesic regimens using patient-controlled analgesia (PCA) with morphine: no background infusion (BO); background infusion 4 micrograms kg-1 h-1 (B4); background infusion 10 micrograms kg-1 h-1 (B10). Total consumption of morphine was greater in group B10 compared with groups B0 (P < 0.01) and B4 (P < 0.05). There was no significant difference in morphine consumption in groups B0 and B4. All three groups self-administered similar amounts of morphine and there were no significant differences in pain scores or incidence of excessive sedation. Group B4 suffered less hypoxaemia compared with groups B0 (P < 0.01) and B10 (P < 0.001). Group B10 suffered more nausea and vomiting than groups B0 (P < 0.001) and B4 (P < 0.001), but there was no significant difference in the incidence of nausea and vomiting between groups B0 and B4. Groups B4 and B10 spent more time at night asleep than group B0 (P < 0.05). There were no significant differences between the groups in the amount of time spent asleep during the day. Inclusion of a background infusion of morphine 4 micrograms kg-1 h-1 in a PCA regimen for children did not increase the incidence of side effects and was associated with less hypoxaemia and a better sleep pattern than no background infusion.
1993
Doyle E; Harper I; Morton NS
British Journal Of Anaesthesia
1993
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/bja/71.6.818" target="_blank" rel="noreferrer">10.1093/bja/71.6.818</a>
Comparison of different bolus doses of morphine for patient-controlled analgesia in children
Child; Female; Male; Pain; Pain Measurement; Time Factors; Non-U.S. Gov't; Comparative Study; Nausea/chemically induced; Human; Support; Adolescence; Patient-Controlled; Sleep/drug effects; Vomiting/chemically induced; Appendectomy; Analgesia; Morphine/administration & dosage/adverse effects; Postoperative/prevention & control
Forty children undergoing appendicectomy were allocated randomly to receive one of two PCA regimens with morphine. Group B10 received bolus doses of 10 micrograms kg-1 and group B20 received bolus doses of 20 micrograms kg-1. In both groups there was a lockout interval of 5 min and a background infusion of 4 micrograms kg-1 h-1. Group B20 self-administered considerably more morphine (P < 0.01) than group B10. There was no difference between the pain scores of the groups at rest. Group B20 had significantly (P < 0.05) smaller pain scores during movement than group B10 and the latter group suffered significantly (P < 0.01) more hypoxaemic episodes than group B20. There were no differences between the groups in the incidence of vomiting, excess sedation or the amount of time spent asleep at night.
1994
Doyle E; Mottart KJ; Marshall C; Morton NS
British Journal Of Anaesthesia
1994
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/bja/72.2.160" target="_blank" rel="noreferrer">10.1093/bja/72.2.160</a>
Using high-dose morphine to relieve cancer pain
Humans; Male; Adult; Infusions; Intravenous; Neoplasms/physiopathology; Morphine/administration & dosage/adverse effects; Oncologic Nursing/methods; Pain/drug therapy/nursing
For cancer patients, the question of how much morphine is too much may be irrelevant-they need as much as it takes to relieve their pain. Discover the principles of administering high doses of morphine, including which routes to use, how to convert doses from one route to another, and which adverse reactions to expect.
1993
Fulton JS; Johnson GB
Nursing
1993
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00152193-199302000-00011" target="_blank" rel="noreferrer">10.1097/00152193-199302000-00011</a>
Intravenous morphine for emergency treatment of cancer pain
Female; Male; Palliative Care; Adult; Analgesics; Aged; 80 and over; retrospective studies; Infusions; Intravenous; Human; Developing Countries; Adolescence; Middle Age; Neoplasms/complications; Morphine/administration & dosage/adverse effects; Emergency Treatment; India; Opioid/administration & dosage/adverse effects; Pain/drug therapy/prevention & control
Despite the wide use of the World Health Organization (WHO) analgesic ladder for the relief of cancer pain, it is not uncommon to find patients presenting with severe pain to palliative care centres. This is more so in the developing world, where facilities for pain relief are few and the health care system is not well organized. It has been the practice in a pain and palliative care clinic in south India to give repeated boluses of 1.5 mg of morphine intravenously every 10 min to patients presenting with severe pain. An audit of the procedure was undertaken by a retrospective study of 793 case notes. Seventy-nine per cent of patients had total relief of their pain with intravenous morphine. Three per cent of patients experienced side-effects during the procedure. These included nausea and vomiting, itching, giddiness, restlessness, dyspnoea, chest pain, disorientation and a feeling of uneasiness. Thirty-two per cent of patients had drowsiness, which was one of the end-points of the procedure. It is concluded that intravenous morphine in repeated boluses of 1.5 mg every 10 min is a safe and effective method of managing cancer pain emergencies in a clinical setting in a developing country.
2000
Kumar KS; Rajagopal MR; Naseema AM
Palliative Medicine
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1191/026921600670697351" target="_blank" rel="noreferrer">10.1191/026921600670697351</a>