Pain
Opioid Side Effects:
Nausea/Vomiting:
Constipation:
- Often exacerbated by dehydratation and inactivity.
- All opioid prescriptions in children should therefore be accompanied by prophylactic stimulant and softening laxatives.
Sedation/ Drowsiness:
- Most children will become drowsy in the first 24 - 48 hours of commencing or increasing the morphine therapy. This usually resolves spontaneously with no need to adjust the dose.
- Explaining this information to both, the child and the family in advance provides reassurance and decreases anxiety
Pruritus:
- Generally responds to antihistamines
- If it is persistent and affecting quality of life, opioid rotation should be considered
Myoclonus:
- It can occur in patients receiving high doses of opioids or in-patients on long term opioid therapy due to accumulation of neurotoxic metabolites such as morphine 3-glucuronide.
- Approaches that are used include benzodiazepines and opioid rotation. (13)
Urinary retention:
- External bladder pressure, intermittent bladder catheterization or opioid rotation are usually used.
Respiratory depression:
- This is the most feared complication. Pain is a very effective stimulant to respiratory drive and apnea is highly unlikely if titration is carried out properly. (13)
- Rarely occurs in children on the palliative care settings. Usually is more frequently seen in neonates due to longer opioid half life caused by immature enzyme systems (2).
