Subcutaneous morphine — a simple technique for postoperative analgesia

Abstract

Abstract An acute pain service (APS) was set up in October 1992 at the University Hospital, Kuala Lumpur to manage postoperative pain. In addition to patient controlled analgesia (PCA) and epidural analgesia, potent opioids were administered subcutaneously for the relief of pain. They were administered regularly via an indwelling subcutaneously placed cannula in patients who could not be offered a PCA pump, either due to a shortage of pumps or an inability to understand its use. From October 1992 to October 1995, 2404 patients were managed by the APS of which 736 patients received subcutaneous opioids. Morphine was used in 571 patients (77.6%), pethidine in 140 patients (19%) and tramadol in 25 patients (3.4%). Eighty percent of the patients gave a satisfaction score (for effective pain relief) of either excellent or good on a 4-point satisfaction scale, ranging from excellent to unsatisfactory. The main reason given for an unsatisfactory rating was due to analgesic drugs not being administered by the nurses as prescribed by the APS. Nausea and vomiting was noted as the main side effect in 12% of patients. The regular subcutaneous administration of a potent opioid, such as morphine, via an indwelling cannula, was found to be a simple, inexpensive, and relatively effective method of providing good postoperative analgesia in the absence of more sophisticated methods, and as such, should be given wider recognition. The APS has also stepped up its education programme for nurses to ensure better compliance with opioid prescriptions.