Is this a lot of morphine?
Discussion
Following on from this thread it now looks like my father (87 in May) has a compression fracture in one vertebrae element.
He's in a surgical ward but they've ruled out surgery due to GA risk.
Currently waiting on a move to an orthopaedic rehab unit but will have a brace fitted first. I'm pleased he's being moved as the other hospital (Woodend) has a good department of medicine for the elderly.
I've spoken to the consultant he's under in the surgical ward. He says that "there is nothing they can do for him apart from manage his pain". He's just waiting for the move to ORU and, let's be frank, he wants his bed back.
In the meantime, my father is sleeping most of the time and rarely coherent when awake.
I took this pic from his notes at the weekend ...
I understand that he is being monitored by the hospital's pain team and I'm guessing that this dosage is set by them.
I further understand that he can (and occasionally does) ask for additional.
Does anyone have a feeling if that amount of morphine would likely cause an elderly man (1.7m / 80kg) to sleep all the time?
Thanks in anticipation.
He's in a surgical ward but they've ruled out surgery due to GA risk.
Currently waiting on a move to an orthopaedic rehab unit but will have a brace fitted first. I'm pleased he's being moved as the other hospital (Woodend) has a good department of medicine for the elderly.
I've spoken to the consultant he's under in the surgical ward. He says that "there is nothing they can do for him apart from manage his pain". He's just waiting for the move to ORU and, let's be frank, he wants his bed back.
In the meantime, my father is sleeping most of the time and rarely coherent when awake.
I took this pic from his notes at the weekend ...
I understand that he is being monitored by the hospital's pain team and I'm guessing that this dosage is set by them.
I further understand that he can (and occasionally does) ask for additional.
Does anyone have a feeling if that amount of morphine would likely cause an elderly man (1.7m / 80kg) to sleep all the time?
Thanks in anticipation.
Edited by Kiltie on Tuesday 11th February 17:58
I am not a doctor but...
The dosage prescribed seems to be 10mg / 5ml, hourly for pain prn (as required, i.e. give 10mg per hour but only if the patient needs it).
Whereas the usual adult dose seems to be 10mg to 20mg every 4 hours: http://www.medicines.org.uk/emc/document.aspx?docu...
So he has been prescribed somewhere between twice and four times the usual dose. There may well be valid medical reasons for this - for example if he's been taking morphine for a while then a tolerance can build up and he may need a higher dose - but equally I can well imagine a dose of this size making an elderly man pretty drowsy!
Hopefully someone medically qualified will come along and give their opinion for you.
The dosage prescribed seems to be 10mg / 5ml, hourly for pain prn (as required, i.e. give 10mg per hour but only if the patient needs it).
Whereas the usual adult dose seems to be 10mg to 20mg every 4 hours: http://www.medicines.org.uk/emc/document.aspx?docu...
So he has been prescribed somewhere between twice and four times the usual dose. There may well be valid medical reasons for this - for example if he's been taking morphine for a while then a tolerance can build up and he may need a higher dose - but equally I can well imagine a dose of this size making an elderly man pretty drowsy!
Hopefully someone medically qualified will come along and give their opinion for you.
the Dose is okay, particulary for an elderly patient.
I assume kidney's are working okay.
The frequency is a little too frequent, assuming the patient is not used to morphine. Usually 4 hourly initally, but frequency can be increased if in alot of pain. However, nursing staff would not continue to give morphine, if a patient is clearly over medicated.They have checks for this.
I think the 1 hourly dose frequency is to try to get on top of the pain relief soon, and then change to a slow release preparation.
Liquid morphine is used very commonly in hospitals,
I assume kidney's are working okay.
The frequency is a little too frequent, assuming the patient is not used to morphine. Usually 4 hourly initally, but frequency can be increased if in alot of pain. However, nursing staff would not continue to give morphine, if a patient is clearly over medicated.They have checks for this.
I think the 1 hourly dose frequency is to try to get on top of the pain relief soon, and then change to a slow release preparation.
Liquid morphine is used very commonly in hospitals,
The highest dose I've ever been on was 30mg every 2 hours - in the aftermath of a really really awful dislocated shoulder along with a badly fractured thumb - so 10mg hourly isn't totally insane for a fractured vertebra, but it is quite a bit and would certainly make him sleepy, especially if he's not recently been on any sort of opiate or opioid.
PRN medicines CAN sometimes end up being offered/given as if they were prescribed regularly/non PRN - do make sure your dad knows that a) it's for when he feels like he needs it, that includes realising he needs it 20 minutes after a nurse last checked he's OK, and b) that it's ABSOLUTELY fine to say "no, thank you" if someone's actually offered it, because it's more than possible for someone who's feeling really lousy to feel like they ought to take it regardless.
I really, really, REALLY hope he is also on lactulose or similar along with all that morphine or he's going to have at least one more source of significant discomfort pretty soon.
Wishing him a swift recovery.
PRN medicines CAN sometimes end up being offered/given as if they were prescribed regularly/non PRN - do make sure your dad knows that a) it's for when he feels like he needs it, that includes realising he needs it 20 minutes after a nurse last checked he's OK, and b) that it's ABSOLUTELY fine to say "no, thank you" if someone's actually offered it, because it's more than possible for someone who's feeling really lousy to feel like they ought to take it regardless.
I really, really, REALLY hope he is also on lactulose or similar along with all that morphine or he's going to have at least one more source of significant discomfort pretty soon.
Wishing him a swift recovery.
Thanks all, that's reassuring.
Thanks.
BlackVanDyke said:
... hope he is also on lactulose or similar ...
The way I understand it, he's not got a lot of control in that respect. He's also been on a feeder via a tube through his nose for a few weeks now (not sure if that makes a difference actually).Thanks.
Kiltie said:
The way I understand it, he's not got a lot of control in that respect. He's also been on a feeder via a tube through his nose for a few weeks now (not sure if that makes a difference actually).
Thanks.
I can grumpily attest that having a tube does not make one immune to constipation, but if things are OK in that regard then that's grand and certainly needs no further worry! Thanks.
Still wishing him a swift recovery - is his pain reasonably well controlled at the moment?
BlackVanDyke said:
Kiltie said:
The way I understand it, he's not got a lot of control in that respect. He's also been on a feeder via a tube through his nose for a few weeks now (not sure if that makes a difference actually).
Thanks.
I can grumpily attest that having a tube does not make one immune to constipation, but if things are OK in that regard then that's grand and certainly needs no further worry! Thanks.
Still wishing him a swift recovery - is his pain reasonably well controlled at the moment?
Indeed, I actually have a photo of my first decent movement after some months on morphine ... I won't be posting it up though.
I remember the text conversation with my wife that morning (I was still in hospital). As I recall, her text to me read something like; "well, if you're sick enough to take a photo of it, I'm sick enough to look at it".
I can laugh about it now but the feeling day after day really was quite unpleasant.
I thought that opioids just "gummed you up". I didn't realise that they stop the muscles working which push everything onward ... as it were.
The things they give you in hospital (senna and the like) I don't think do anything at all.
I also don't think they properly monitor input Vs output.
Not nice.
Sorry for being so graphic.
I think it's not a good idea to second guess your father's care. If you have concerns you should discuss these with the nurses, or ideally attending Doctor, they'll reassure you. If you find them unaccommodating at first, it'll simply be because they are busy, but if you insist you need reassurance in a polite manner they will arrange for a medic to briefly talk you through it.
Even the best Doctor in the world won't be able to tell you if he's on adequate pain relief from a screen shot of a single medicine he is taking, let alone a bunch of armchair experts. It simply isn't enough information.
Even the best Doctor in the world won't be able to tell you if he's on adequate pain relief from a screen shot of a single medicine he is taking, let alone a bunch of armchair experts. It simply isn't enough information.
Hi Prof.
Surprised by your disapproving tone.
No difference between me asking on PH or discussing it in the pub don't you think?
Don't worry, I won't be calling clinical negligence based on some PH replies.
I think the care my dad is getting is fine. I just wondered if anyone else had had experience of old people taking morphine. That's all.
Regarding getting my information from the horse's mouth; yes you're absolutely correct. Unfortunately, circumstances don't make this too easy.
Surprised by your disapproving tone.
No difference between me asking on PH or discussing it in the pub don't you think?
Don't worry, I won't be calling clinical negligence based on some PH replies.
I think the care my dad is getting is fine. I just wondered if anyone else had had experience of old people taking morphine. That's all.
Regarding getting my information from the horse's mouth; yes you're absolutely correct. Unfortunately, circumstances don't make this too easy.
tters around pistonheads who may worry you unnecessarily or let you make an arse of yourself.
I work with the elderly in a medical capacity of but I'm not a doctor...
However ignoring the fact that morphine will make you drowsy you should also take into account that his body has recently been through a lot of trauma and I find that with the elderly that they 'take to their beds' and therefore sleep a lot so the body can repair the damage...
Unfortunately due to their age this will take a lot longer than an average adult... So this along with the sedative effects of Oramorph will probably explain his drowsiness..
As another poster put it I'd ask to speak to a doctor if you are concerned about him but from my experience he will be regularly monitored via his observations (obs) and if there was any concerns they would act.... His probably within the NEWS limits for obs anyways so that's why there isn't any immediate concern...
But please ask as we need to be aware of treating the patients and carers as well.
Hope this helps.
Benjurs
However ignoring the fact that morphine will make you drowsy you should also take into account that his body has recently been through a lot of trauma and I find that with the elderly that they 'take to their beds' and therefore sleep a lot so the body can repair the damage...
Unfortunately due to their age this will take a lot longer than an average adult... So this along with the sedative effects of Oramorph will probably explain his drowsiness..
As another poster put it I'd ask to speak to a doctor if you are concerned about him but from my experience he will be regularly monitored via his observations (obs) and if there was any concerns they would act.... His probably within the NEWS limits for obs anyways so that's why there isn't any immediate concern...
But please ask as we need to be aware of treating the patients and carers as well.
Hope this helps.
Benjurs
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