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MORPHINE: OTHER ROUTES OF ADMINISTRATION-DOSE AND INTRAVENTRICULAR MORPHINE

The dose of morphine used for spinal therapy depends on the route of administration and the patient’s current opioid therapy. The dose is then adjusted according to effect and toxicity.
Spinal morphine is not without central side effects and respiratory depression, sedation, dysphoria, nausea and vomiting are all reported. However, the incidence is much less in cancer patients who have previously been receiving systemic morphine than in opioid naive patients. If severe, treatment is with small doses of naloxone. Occasionally, physical withdrawal symptoms occur if systemic opioid therapy is stopped after commencement of spinal therapy; in the absence of signs of respiratory depression, the previous systemic therapy should be weaned over several days.
Systemic side effects including urinary retention and constipation can occur but are less common and less severe in cancer patients who are not opioid naive.
High doses or high concentrations of spinal morphine may produce hyperaesthesia, dysaesthesia or myoclonus.
Tolerance will develop with continued spinal therapy, necessitating dose increments. There is no evidence that tolerance is particularly more or less likely to develop than with systemic therapy, and fear of tolerance is not a reason to withhold spinal therapy if it is indicated.
Intraventricular morphine-There are reports describing the administration of morphine into the cerebral ventricles of patients suffering uncontrolled pain related to advanced cancer. Whilst good pain relief is reported, the role of this therapy requires further evaluation and should be regarded as experimental at this time.
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