MORPHINE: OTHER ROUTES OF ADMINISTRATION-INDICATIONS, CONTRAINDICATIONS AND ADMINISTRATION
Spinal morphine should be considered for patients with:
• pain not controlled by optimal systemic opioid therapy
• intolerable side effects from systemic treatment
Spinal morphine is most likely to be successful with deep somatic and visceral pain. Neuropathic pain is less sensitive although good results are achieved for some patients; the response may be better if a combination of local anaesthetic and morphine is given by epidural injection.
Contraindications-Spinal morphine is contraindicated in patients who:
• have a significant bleeding tendency or are anticoagulated
• have septicaemia or significant risk of septicaemia
Spinal metastases need not be a contraindication but the catheter should be sited away from known tumour and better results are likely if it is rostral to the tumour.
Administration-Morphine is administered via a catheter placed in either the epidural or subarachnoid space. Epidural morphine is usually given by bolus injection each 6-12 hours, subarachnoid by continuous infusion. Epidural catheters may be sited at the painful segments and this method has the advantage of allowing the co-administration of local anaesthetic agents which may significantly aid pain control. Subarachnoid catheters are placed below the level of L 2. The spinal catheter may be connected to a subcutaneously implanted reservoir or brought out through the skin for intermittent injection or attachment to an external pumping device. The morphine used for spinal therapy should be preservative free.
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