Morphine (Orthopaedic Acute Pain)

ROUTE CAVEAT: the fetched UK SPC is Morphine 10 mg/5 ml Oral Solution, so this source gives ORAL dosing only. It contains NO intravenous, subcutaneous or intramuscular morphine regimen — the parenteral doses commonly used for acute orthopaedic and post-operative pain are not covered by this bundle and must be sourced separately. The SPC notes that when the oral solution is used in place of parenteral morphine, a 50% to 100% increase in dosage is usually required to achieve the same level of analgesia. Dosage can be increased under medical supervision according to the severity of the pain and the patient's previous history of analgesic requirements. Reductions in dosage may be appropriate in the elderly and in patients with chronic hepatic disease, renal impairment, severe hypothyroidism, adrenocortical insufficiency, prostatic hypertrophy, shock, or where sedation is undesirable. Before initiating, agree a treatment strategy including duration, goals and a plan for ending treatment; maintain frequent physician–patient contact; taper gradually when therapy is no longer required to prevent withdrawal. Should not be used longer than necessary. In the absence of adequate pain control, consider hyperalgesia, tolerance and progression of the underlying disease. When transferring from other morphine preparations, dosage titration may be appropriate. PAEDIATRIC: the SPC gives age-banded oral regimens for 13–18 years, 6–12 years and 1–5 years, and states morphine oral solution is not recommended in children under 1 year. Verify any paediatric dose against a children's formulary. Source quote (§4.2): 'Adults: Recommended dose: 10-20 mg (5-10 ml) every 4 hours. Maximum daily dose: 120 mg per day'.