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Palliative Care

 

 

Pain

 

Morphine

Morphine is the most commonly used opioid for moderate and severe pain in pediatric palliative care.

Morphine is an opioid receptor agonist that binds and activates the mu opioid receptors in the central nervous system.

Almost all morphine is converted by hepatic metabolism to the 3-and 6- glucuronide metabolites (M3G and M6G) (2).

Morphine elimination is renal, so caution needs to be taken in patients with renal failure as metabolites can accumulate in blood.

Different administration routes can be used: oral, sublingual, subcutaneous, intravenous, rectal, intrathecal and epidural.

 

Table 1. Adapted from Dosing Guideline for Morphine in Children, (H.Siden) (3)

Route

Younger Child

< 50 kg

Older Child

> 50 kg

Comments

Response Time

Duration of action

Oral

(PO)

0.15-0.3 mg/kg q 4 hr

5-30 mg q4h

 

45-60 min

 

Extended release

 

 

Convert from short acting

 

12 hrs is usual

Sub-

cutaneous

(SC)

0.05-0.1 mg/kg q 4h

5-10 mg q 4 h

 

 

 

IV intermittent

 

5-10 mg q 4 h

 

10 min

 

IV/SC infusion

10-20 mcg/kg/hr are usual starting doses in opioid naive patients

 

Titrate upward-provide with basal rate and breakthrough-patient or nurse PCA

 

 

 

 

 

 

 

 

 

 

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