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Intravenous morphine for breakthrough (episodic-) pain in an acute palliative care unit: a confirmatory study.
J Pain Symptom Manage. 2008 Mar; 35(3):307-13.JP

Abstract

The aim of this prospective cohort study was to confirm the safety of intravenous morphine (IV-M) used in doses proportional to the basal opioid regimen for the management of breakthrough pain and to record the nurse compliance on regularly recording data regarding breakthrough pain treated by IV-M. Over a one-year period, 99 patients received IV-M for breakthrough pain during 116 admissions. The IV-M dose was 1/5 of the oral daily dose, converted using an equianalgesic ratio of 1/3 (IV/oral). For each episode, nurses were instructed to routinely collect changes in pain intensity and emerging problems when pain became severe (T0), and to reassess the patient 15minutes after IV-M injection (T15). Nurses were unaware of the aim of the study and just followed department policy. In total, 945 breakthrough events treated by IV-M were recorded and the mean number of events per patient per admission was eight (95% confidence interval (CI) 6.9-9.5). The mean dose of IV-M was 12mg (95% CI 9-14mg). In the 469 events (49.6%) with a complete assessment, a decrease in pain of more than 33% and 50% was observed in 287 (61.2%) and 115 (24.5%) breakthrough events, respectively. The mean pain intensity decreased from 7.2 (T0) to 2.7 (T15). In eight episodes, no changes in pain intensity were observed and a further dose of IV-M was given. The remaining patients did not require further interventions. No clinical events requiring medical intervention were recorded. In this confirmatory study, IV-M was administered for the management of breakthrough pain in doses proportional to the basal opioid regimen to all patients, including older patients and those requiring relatively large doses. This did not result in life-threatening adverse effects in a large number of patients and was effective in most cases. The role of nurses is of paramount importance in monitoring and collecting data and gathering information for audit purposes on the unit.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Mercadante S
Anesthesia and Intensive Care Unit & Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, University of Palermo, Palermo, Italy. terapiadeldolore@lamaddalenanet.it
Intravaia G
No affiliation info available
Villari P
No affiliation info available
Ferrera P
No affiliation info available
Riina S
No affiliation info available
Mangione S
No affiliation info available

MeSH

AgedAnalgesics, OpioidFemaleHumansInjections, IntravenousMaleMiddle AgedMorphinePainPalliative CareProspective Studies

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

18178368

Citation

Mercadante, Sebastiano, et al. "Intravenous Morphine for Breakthrough (episodic-) Pain in an Acute Palliative Care Unit: a Confirmatory Study." Journal of Pain and Symptom Management, vol. 35, no. 3, 2008, pp. 307-13.
Mercadante S, Intravaia G, Villari P, et al. Intravenous morphine for breakthrough (episodic-) pain in an acute palliative care unit: a confirmatory study. J Pain Symptom Manage. 2008;35(3):307-13.
Mercadante, S., Intravaia, G., Villari, P., Ferrera, P., Riina, S., & Mangione, S. (2008). Intravenous morphine for breakthrough (episodic-) pain in an acute palliative care unit: a confirmatory study. Journal of Pain and Symptom Management, 35(3), 307-13. https://doi.org/10.1016/j.jpainsymman.2007.04.018
Mercadante S, et al. Intravenous Morphine for Breakthrough (episodic-) Pain in an Acute Palliative Care Unit: a Confirmatory Study. J Pain Symptom Manage. 2008;35(3):307-13. PubMed PMID: 18178368.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intravenous morphine for breakthrough (episodic-) pain in an acute palliative care unit: a confirmatory study. AU - Mercadante,Sebastiano, AU - Intravaia,Giuseppe, AU - Villari,Patrizia, AU - Ferrera,Patrizia, AU - Riina,Salvatore, AU - Mangione,Salvatore, Y1 - 2008/01/07/ PY - 2007/01/30/received PY - 2007/04/11/revised PY - 2007/04/12/accepted PY - 2008/1/8/pubmed PY - 2008/4/25/medline PY - 2008/1/8/entrez SP - 307 EP - 13 JF - Journal of pain and symptom management JO - J Pain Symptom Manage VL - 35 IS - 3 N2 - The aim of this prospective cohort study was to confirm the safety of intravenous morphine (IV-M) used in doses proportional to the basal opioid regimen for the management of breakthrough pain and to record the nurse compliance on regularly recording data regarding breakthrough pain treated by IV-M. Over a one-year period, 99 patients received IV-M for breakthrough pain during 116 admissions. The IV-M dose was 1/5 of the oral daily dose, converted using an equianalgesic ratio of 1/3 (IV/oral). For each episode, nurses were instructed to routinely collect changes in pain intensity and emerging problems when pain became severe (T0), and to reassess the patient 15minutes after IV-M injection (T15). Nurses were unaware of the aim of the study and just followed department policy. In total, 945 breakthrough events treated by IV-M were recorded and the mean number of events per patient per admission was eight (95% confidence interval (CI) 6.9-9.5). The mean dose of IV-M was 12mg (95% CI 9-14mg). In the 469 events (49.6%) with a complete assessment, a decrease in pain of more than 33% and 50% was observed in 287 (61.2%) and 115 (24.5%) breakthrough events, respectively. The mean pain intensity decreased from 7.2 (T0) to 2.7 (T15). In eight episodes, no changes in pain intensity were observed and a further dose of IV-M was given. The remaining patients did not require further interventions. No clinical events requiring medical intervention were recorded. In this confirmatory study, IV-M was administered for the management of breakthrough pain in doses proportional to the basal opioid regimen to all patients, including older patients and those requiring relatively large doses. This did not result in life-threatening adverse effects in a large number of patients and was effective in most cases. The role of nurses is of paramount importance in monitoring and collecting data and gathering information for audit purposes on the unit. SN - 0885-3924 UR - https://www.unboundmedicine.com/medline/citation/18178368/Intravenous_morphine_for_breakthrough__episodic___pain_in_an_acute_palliative_care_unit:_a_confirmatory_study_ DB - PRIME DP - Unbound Medicine ER -