Back to the case:
In order to achieve satisfactory pain control in a timely manner, parenteral short-acting opioid regimen is started initially with Morphine 10 mg IV every 3 hours around the clock with additional 5 mg every 1-2 hours as needed. You re-assess Mr. M early the next AM (18 hours after initiating the regimen above) and gather the following information:
- Pain scores: best - 1/10; worst - 5/10; current 2/10.
- Number of breakthrough doses used: 5 (5 mg each)=25 mg.
- Scheduled IV morphine over 18 hours = 6 doses x 10mg= 60 mg
- He has had 2 large stools and nausea is much improved.
You discuss with the team a plan to transition back to oral morphine. Your resident tells you they’ll wait till tomorrow to switch to back to all oral morphine, but asks you to come up with a suggested oral morphine order for Mr. M based on his current IV morphine usage over the past 18 hours.