Therapeutic Handbook - GGC Prescribing

Analgesics for acute pain – prescribing notes continuedStep 3. Strong opioids for severe painMorphine oral:AgeInitial Dose< 70 years 10 mg every 1 - 2 hours (regularly monitor / review sedationscore and respiratory rate).> 70 years 5 mg every 1 - 2 hours (regularly monitor / review sedationscore and respiratory rate).Morphine IV – post-operative administration:Central Nervous SystemAgeDose< 65 years 1 - 2 mg at 5 minute intervals, up to a maximum of 10 mgthen reassess65 - 80 years 1 mg at 10 minute intervals> 80 years 0.5 - 1 mg at 10 minute intervalsGeneral notes on morphine• Morphine should be prescribed on an age-related basis rather than weight-related.• Adding paracetamol and/or an NSAID can reduce opioid dose requirements and enhanceanalgesic effect of morphine.• Titrate dose of morphine to response, monitor closely for oversedation and respiratorydepression (refer to page 41)• Co-prescribe a stimulant laxative (see page 45 on Management of Constipation).• Co-prescribe an antiemetic. Patients with a history of post-operative nausea and vomiting(PONV) or who are at high risk may particularly benefit from prophylactic antiemetics (seepage 164 on Management of PONV).Caution:• In renal and hepatic impairment seek dosing advice from your ward pharmacist or seniormember of staff.Notes on parenteral morphine• For subcutaneous morphine (acute, pre- or post-operative pain) refer to local protocols.• Use IV only to initiate analgesia, or as PCA. It should not be used as breakthrough analgesiaand patients must be closely monitored during and after administration for oversedation andrespiratory depression.• Consider oral morphine when parenteral morphine is discontinued.Continues on next pagePage 162