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Morphine Sulfate

- Discussion:
    - adult:
          - 0.1-0.3 mg/kg/dose IM/IV/SC
          - 8-20mg PO q4hr, 30mg (MS Contin) PO q8-12 hr / 5-15 mg SQ/IM q4hr
          - IM/SC: Max. analgesic effect at 45-60 min; duration 3-4 hrs; t/2: 2-3 hr;
          - 4-10mg IV diluted and injected slowly over 5' q3-4 hr prn;
          - parental 1-10 mg/hr;
          - IV: Max. CNS effect at 30 min; (maximum resp depression: 10-30 min - duration exceeds analgesic effects);
    - peds: 0.1-0.2 mg/kg/dose SQ/IM/IV q2-4hrs prn up to max 15 mg/dose;

- Cautions:
    - metabolism: conjugated in liver, excreted in kidney (90%)
    - may cause hypotension and respiratory depression (inititally check before and after each dose, SBP > 90mm);
    - nausea / vomiting: give w/ antiemetics
    - histamine release: bronchospasm / urticarial/ anaphylaxis
    - profound hypotension may occur in pts who are hypovolemic and receive narcotics;
    - may be contraindicated in patients who have recently taken MAOI inhibitors

Efficacy of intermittent epidural morphine following posterior spinal fusion in children and adolescents.

The effect of continuous epidural analgesia on postoperative pain, rehabilitation, and duration of hospitalization in total knee arthroplasty.

Analgesic effect of intraarticular morphine after arthroscopic knee surgery [see comments]

Intra-articular morphine for pain relief after knee arthroscopy.

Analgesic effect of intraarticular bupivacaine or morphine after arthroscopic knee surgery: a randomized, prospective, double-blind study.