Morphine, managing adverse

OxyContin is a controlled-released form of oxycodone and indicated for the management of moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period of time OxyContin is not intended for use as a PRN analgesic The patient may experience fewer adverse reactions with oxycodone tlian morphine, and the drug is effective and safe for the elderly. The tablets are to be swallowed whole and are not to be broken, chewed, or crushed. 

This type of pain management is used for postoperative pain, labor pain, and cancer pain. The most serious adverse reaction associated with the administration of narcotics by the epidural route is respiratory depression. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. Fentanyl is increasingly used as an alternative to morphine sulfate because patients experience fewer adverse reactions. 

Intolerable adverse effects or inadequate analgesia occur in 10-15% of patients with chronic pain given continuous intrathecal morphine. Hydromorphone is a semisynthetic derivative of morphine used extensively in the management of cancer pain. It is more soluble than morphine, has a slightly shorter duration of action, and is about five times more potent when given systemically. 

The strategies used in managing the adverse effects of oral morphine have been reassessed in another special article compiled by the Expert Working Group of the European Association of Palliative Care Network (5). Factors that predict opioid adverse effects include ... 

The use of opioids in very young patients is increasing. In a review of pain management in children, various routes of administration of opioids and their associated adverse effects have been discussed (SEDA-17, 78). Attention has been drawn to the adverse effects of intravenous codeine in children and to the risk of convulsions with pethidine in neonates, because of accumulation of its metabolite norpethidine. The risk of respiratory depression with morphine was also highlighted, and morphine is recommended for use only in neonates who are being ventilated or intensively nursed. Routine use of pulse oximetry has been recommended in all children receiving opioids (SEDA-21, 86). 

The effects of a combination of morphine and a subanesthetic dose of ketamine have been studied in 41 patients undergoing thoracotomy in a double-blind, randomized study [131. The addition of ketamine reduced morphine consumption by 45%, achieved equivalent pain management, and was associated with fewer adverse events. 

Cherny N, Ripamonti C, Pereira 1, et al. Strategies to manage the adverse effects of oral morphine an evidence-based report. / Clin Oncol 2001 19 2542-2554. 

Fentanyl is a synthetic opioid analgesic, introduced in the 1950s, that has enhanced analgesic activity and potency and fewer adverse effects compared with morphine or meperidine. Structurally related to meperidine, fentanyl gained wide popularity as an intra-operative anesthetic adjunct as well as an effective analgesic for the management of acute and chronic pain. 

Observational studies Tincture of opium is a preparation of powdered opium, which contains morphine, codeine, papaverine, and alcohol. It is used as an antidiarrheal agent, to treat neonatal abstinence syndrome, in the management of pain, and traditionally for the management of opioid dependency in some Asian countries. In an open study, opium-dependent subjects were allocated to three different doses of tincture of opium twice a day 10 ml (6.66 mg morphine equivalents n = 13), 20 ml (13.3 mg morphine equivalents n = 8), and 30 ml (20 mg morphine equivalents n = 11) [1 j. In all the subjects tincture of opium effectively suppressed withdrawal symptoms without causing significant adverse effects. 

Morphine (mean dose 112 mg) and mex-iletine (mean dose 933 mg) have been compared in the management of postamputation pain in a double-blind, randomized, placebo-controlled, crossover study in 60 patients [105 ]. Morphine was associated with a higher rate of adverse effects, mainly constipation (17 versus two), drowsiness (nine versus four), and nausea (four versus zero). 

Management of adverse drug reactions Dexmedetomidine Combining dexmedeto-midine 5 micrograms/ml and morphine 1 mg/ml in intravenous patient-controlled analgesia resulted in better analgesia, reduced morphine consumption, and a reduced incidence of nausea and vomiting... 

MANAGEMENT OF ADVERSE DRUG REACTIONS Administration of butorphanol, a partial agonist and antagonist of the mu receptor, was able to prevent morphine-induced pruritus without increasing effects of opiate withdrawal including nausea and vomiting [59 ]. 

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