Tag Archives: morphine

How Much Morphine Should Be Prescribed?

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In comparison to other medications, opioid pain medications are more carefully regulated, have the potential for more severe adverse reactions, and written prescriptions are needed for dispensing. So, trying to provide the right amount is a little tricky. With this background, a recent study (M Aboud-Karam et al. J Pediatr 2015; 167: 599-604) examines the use of morphine after pediatric surgery.

This prospective study included 243 subjects. Findings:

  • 56% of participants who received a scheduled (“regular basis”) prescription administered the medication as ordered.  The most common reason for deviation was a lack of pain or mild pain relieved by acetaminophen.  33 of the 104 patients who received a scheduled prescription did not even pick up the medication from the pharmacy.
  • 85% of participants in the “as needed” prescription group were administered morphine as ordered; however, 76% of this group took two or fewer doses. In this “as needed” group, a subset of 77 participants had precise data about the amount of morphine that they received.  Less than 10 % of the prescription doses available were administered.

The authors note that morphine is covered in Canada by both private and government-based insurance plans such that there are unlikely to be financial constraints limiting medication usage.  They note that the unused medication is a safety hazard due to potential for accidental ingestions.

My take: this study suggests that prescriptions with fewer doses of morphine may be warranted.

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Using NSAIDs After Tonsillectomy & More on Coffee

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Many times all of the treatment choices are flawed and choosing the least worst option is required.  A recent study (Kelly LE et al. Pediatrics 2015; 135: 307-13) helps provide some useful data regarding pain management in the setting of tonsillectomy.  I chose to highlight this study because the findings seem at odds with what I would have predicted; that is, I was surprised that, in this small study, use of ibuprofen was not associated with increased bleeding risk.

Background: More than 500,000 tonsillectomies are performed on pediatric patients each year in the U.S.  Pain control afterwards has been problematic.  Codeine-containing products now have a black-box warning for post-tonsillectomy analgesia due to risk of life-threatening respiratory failure.  So choosing between a different narcotic agent like morphine or using a nonsteroidal anti-inflammatory drug (NSAID) which could contribute to bleeding is not clear cut.  While morphine’s metabolism is more predictable than codeine, all narcotics have the potential to suppress breathing.  In addition, patients undergoing tonsillectomy have a higher risk of breathing abnormalities than the general population.

Design: Randomized control trial with 91 children aged 1 to 10 years.

Key findings:

  • No significant difference in reported pain control
  • Similar frequency of tonsillar bleeing –3 in children with ibuprofen and 2 who received morphine.
  • Children in the ibuprofen group were much more likely to see an improvement in oxygen desaturations on the first postoperative night: 68% compared to 14%.
  • One child in the morphine group had a severe drug reaction requiring admittance to the intensive care unit.

Take-home point: The researchers concluded that ibuprofen is as effective as and safer than morphine for post tonsillectomy analgesia in children, without a higher risk of bleeding.

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More on coffee:

I often have discussed with families how coffee can improve bowel frequency.  Here is a link on that topic from Huffington Post:  “Why Does Coffee Make You Poop?”

Previous blogs on coffee:

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.