Subcutaneous morphine in children: taking the sting out of postoperative analgesia

Lavies, N. G.; Wandless, J.G.

doi:10.1111/j.1365-2044.1989.tb09214.x

Cited by 15 publications

(6 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14,15 Additionally, multiple studies have demonstrated that alternative, potentially safer methods of administration such as subcutaneous injection, as well as oral administration when possible, are as effective as the IV route in a variety of clinical contexts. [16][17][18][19][20][21] Furthermore, a recent study found that the implementation of an opioid prescribing standard of care intervention favoring oral and subcutaneous routes of opioid administration led not only to a decrease in IV opioid administration, but to overall decreases in any opioid administration and overall total opioid exposure in MME, while maintaining effective pain control. 22 A possible explanation for the high rate of IV opioid use in our study population is the lack of a similar standard of practice program at our institution, as well as an underappreciation of alternative methods of administration such as subcutaneous dosing.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Inpatient Opioid Prescribing Resulting in Outpatient Opioid Prescriptions for Previously Opioid-Naive Internal Medicine Patients

Perkins

Huckleberry

Bogdanich

et al. 2020

Journal of Pharmacy Practice

View full text Add to dashboard Cite

Background: Little data exist regarding inpatient opioid prescriptions as a potential contribution to the current opioid crisis. While pain management is essential to inpatient care, the ease of which opioids may be prescribed for all levels of pain may contribute to unnecessary inpatient exposure and new outpatient prescriptions. The aim of this study was to observe patterns of opioid prescribing potentially leading to new opioid prescriptions at hospital discharge for previously opioid-naive patients. Methods: This study was a single-center observational study of opioid-naïve internal medicine patients who were prescribed inpatient opioids. Patient charts were reviewed to assess the patterns of inpatient opioid and non-opioid analgesic use, new opioid prescriptions upon discharge and medical record documentation justifying the need for outpatient therapy. Results: Among the 101 patients included in this study, 71 were prescribed IV opioids and 45 were prescribed both IV and oral opioids. Non-opioid analgesics were available for 78 patients. Twenty patients were discharged with a new prescription. The mean duration of outpatient prescriptions was 3.85 +/- 1.85 days with mean morphine milligram equivalents (MME) of 44.25 +/- 22.16. Among patients receiving these outpatient prescriptions, 11 had reference to the therapy in the discharge summary. Conclusions: This observational study describes an opportunity to improve inpatient opioid prescribing practices which may reduce new prescriptions for continued outpatient therapy. Further work should focus on optimizing use of non-opioid analgesia, minimizing use of IV opioids and requiring prescribers to justify the indication for new opioid prescriptions upon hospital discharge.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation of Inpatient Opioid Prescribing Resulting in Outpatient Opioid Prescriptions for Previously Opioid-Naive Internal Medicine Patients

Perkins

Huckleberry

Bogdanich

et al. 2020

Journal of Pharmacy Practice

View full text Add to dashboard Cite

show abstract

“…The use of an indwelling subcutaneous catheter does have potential advantages over the intramuscular route in terms of patient comfort by avoiding repeated injections [14] and also reduces the risk of needle stick injuries to the carer [7]. Although similar advantages could be postulated with an indwelling intramuscular cannula [15], the deeper penetration of the needle and movement of the muscle may make this placement of the cannula uncomfortable for the patient.…”

Section: Discussionmentioning

confidence: 99%

Morphine blood concentrations in elderly postoperative patients following administration via an indwelling subcutaneous cannula

et al. 1997

View full text Add to dashboard Cite

SummaryThe pharmacokinetics of morphine in venous blood after a 5 mg bolus dose via an indwelling subcutaneous cannula were characterised in 22 elderly patients undergoing elective major surgery. In a subgroup of seven patients, the kinetics were also characterised after a second 5 mg dose of morphine administered 180 min after the first dose. Blood morphine concentrations following the single dose were highly variable -the coefficients of variation of C max , T max and the AUC up to 180 min (AUC 180 ) were 54, 37 and 39%, respectively, with mean values of 86.6 ng.ml ¹1 , 15.9 min and 3954 ng.ml ¹1 , respectively. These mean values for the second dose were not statistically different to those of the first dose but were more variable. It was concluded that the injection of morphine via an indwelling subcutaneous cannula results in blood concentrations that are comparable to, and as variable as, those arising from intramuscular injection.

show abstract

“…There is however little clinical data on the efficacy of subcutaneous boluses as opposed to infusions. A study conducted in children suggested good efficacy and acceptance 11 but the methodology of this study has been criticized 12 .…”

mentioning

confidence: 92%

Morphine for Postoperative Analgesia. A Comparison of Intramuscular and Subcutaneous Routes of Administration

Cooper

1996

Anaesth Intensive Care

View full text Add to dashboard Cite

Intermittent parenteral bolus doses of morphine are commonly used for postoperative analgesia. Morphine is typically given by intramuscular or intravenous injection but there are theoretical advantages for the subcutaneous route of administration. Fifty-nine patients entered a prospective randomized double-blind cross-over study comparing intermittent intramuscular and subcutaneous morphine boluses. Patients received 0.15 mg/kg of morphine by subcutaneous or intramuscular injection. They were reviewed at the time of injection, after 15 minutes and each hour for four hours. The majority of patients indicated a strong preference for the subcutaneous route. There were no significant differences in pain scores, respiratory rate, arterial oxygen saturation, heart rate, mean arterial pressure, sedation or nausea scores between intramuscular and subcutaneous administration of morphine. Postoperative analgesia by subcutaneous morphine bolus injection is as effective as intramuscular injection with a similar side-effect profile but with greater patient acceptance and less risk.

show abstract

Subcutaneous morphine in children: taking the sting out of postoperative analgesia

Cited by 15 publications

References 4 publications

Evaluation of Inpatient Opioid Prescribing Resulting in Outpatient Opioid Prescriptions for Previously Opioid-Naive Internal Medicine Patients

Evaluation of Inpatient Opioid Prescribing Resulting in Outpatient Opioid Prescriptions for Previously Opioid-Naive Internal Medicine Patients

Morphine blood concentrations in elderly postoperative patients following administration via an indwelling subcutaneous cannula

Morphine for Postoperative Analgesia. A Comparison of Intramuscular and Subcutaneous Routes of Administration

Contact Info

Product

Resources

About