Regular subcutaneous bolus morphine via an indwelling cannula for pain from advanced cancer

Abstract

The analgesia and toxicity of regular four-hourly subcutaneous bolus morphine were assessed prospectively in 164 patients with pain from advanced cancer; each had received oral morphine for a minimum of 48 hours. World Health Organization (WHO) scores for pain, nausea and vomiting, and drowsiness taken at the time of change to subcutaneous bolus morphine and 48 hours later indicated that subcutaneous morphine provided significantly better analgesia than similar doses of oral morphine (p<0.001) and was associated with significantly less nausea and vomiting (p < 0.005). Scores for drowsiness were similar for both forms of morphine. Minor erythema or thickening at the injection site was noted in 86 patients (52%), but more severe local reactions occurred in seven patients (4%). Twenty-five patients (15%) were discharged home on subcutaneous bolus morphine given by themselves or relatives. Regular four-hourly subcutaneous bolus morphine is an effective and well tolerated method of parenteral morphine administration.