Administration Of Diamorphine Research Articles

Carer preferences of route of administration of transmucosal diamorphine and willingness to take part in a randomised controlled trial: an interview study (DIPPER)

BackgroundChildren and young people are usually given liquid morphine by mouth for breakthrough pain, which can take thirty minutes to work. A faster-acting, quickly absorbed, needle-free pain medicine, that is easy to administer is needed such as transmucosal (sublingual, buccal, intranasal) diamorphine. Research evidence relating to the administration of medication for breakthrough pain in children and young people is limited. This study aims to describe the experiences and preferences of parents and/or children and young people regarding the route of administration of diamorphine, barriers and facilitators comparative to oral morphine, and participation in a randomised controlled trial.MethodsIn-depth, semi-structured interviews with parents and/or children and young people at home or hospital/hospice.ResultsThirteen interviews with: nine mothers, one father, and three sets of parents jointly. No interviews took place with a child/young person. Most families had experience of the buccal route which was effective in ease of administration and time to control pain. The intranasal route was preferred by parents irrespective of experience. Parents’ willingness for their child to take part in a trial depended on the time commitment, their child’s pain trajectory and the stability of analgesic requirements.ConclusionA randomised controlled trial of oral morphine versus transmucosal diamorphine would need to consider trial logistics, especially time commitment. Parents felt that the trial should be introduced initially by the clinical team, with written information from the research team, and sufficient time to ask questions. Patients who had discontinued oral morphine because of side effects, or those with gastrointestinal failure, should be excluded. Maintaining stability in pain management was essential to families, so the timing of the trial is a potential issue.

Letter.

The report (Emergency Nurse, November) on the welcome regulatory changes that now permit the administration of diamorphine under patient group direction contains an error.

An unusual complication following combined spinal-epidural anaesthesia for caesarean section

The combined spinal-epidural technique is widely used in obstetric anaesthetic practice. Epidural catheter migration through a dural hole is a theoretical but rarely described complication. We report a case of acute and life-threatening respiratory depression following administration of diamorphine through an epidural catheter after a single space combined spinal-epidural technique for caesarean section. We believe this complication occurred as a result of catheter migration through a dural hole into the subdural space and rupture of the thin arachnoid layer causing massive subarachnoid blockade.

Hypoxaemia and Pain Relief After Lower Abdominal Surgery

We have examined postoperative pain in patients allocated randomly to receive extradural bolus diamorphine 3.6 mg, extradural infusion of 0.15% bupivacaine with 0.01% diamorphine or patient-controlled i.v. administration of diamorphine at a maximum rate of 1 mg per 5 min, after total abdominal hysterectomy. Extradural infusion analgesia produced the smallest pain scores from 12 to 24 h after surgery (P 12 min h-1) after operation, compared with the two other groups (P < 0.05). The group using patient-controlled analgesia received more diamorphine and suffered a greater incidence of emetic sequelae (P < 0.05).

HYPOXAEMIA AND PAIN RELIEF AFTER LOWER ABDOMINAL SURGERY: COMPARISON OF EXTRADURAL AND PATIENT-CONTROLLED ANALGESIA

We have examined postoperative pain in patients allocated randomly to receive extradural bolus diamorphine 3.6 mg, extradural infusion of 0.15% bupivacaine with 0.01% diamorphine or patient-controlled i.v. administration of diamorphine at a maximum rate of 1 mg per 5 min, after total abdominal hysterectomy. Extradural infusion analgesia produced the smallest pain scores from 12 to 24 h after surgery (P < 0.05). More patients in the extradural infusion group were moderately hypoxaemic (SpO2 < 90% > 12 min h-1) after operation, compared with the two other groups (P < 0.05). The group using patient-controlled analgesia received more diamorphine and suffered a greater incidence of emetic sequelae (P < 0.05).

Diamorphine infusion in the preterm neonate.

The effects of diamorphine were studied in 34 premature neonates who were given a loading dose of 50 micrograms/kg of diamorphine followed by a constant rate intravenous infusion of 15 micrograms/kg/hour. Small but significant falls were noted in blood pressure (at 30 minutes) and heart rate (at 30 minutes, six hours, and 12 hours) after administration of diamorphine, but these did not appear to cause any clinical deterioration and were thought to be related to the sedative effect of the drug. A significant fall in respiration rate at 30 and 60 minutes reflected the desired intention to encourage synchronisation of the infants' breathing with the ventilator. The mean (SD) plasma concentration of morphine measured during the infusion at steady state was 62.5 (22.8) ng/ml (range 20 to 98 ng/ml). The data suggest that this dosage regimen of diamorphine is safe. It results in plasma concentrations of morphine in the premature neonate which are comparable with those that are known to provide effective analgesia in the child and adult.