Having done clinicals in general and neuro step-down units, yeah, I was surprised at the number of patients either on a morphine drip or an as-needed (PRN) IV push. For post-surg, it is absolutely essential and there are plenty of stable conditions that still demand morphine to address secondary pain.
But, because of its retardant effect on peristalsis (translation: constipation), any morphine therapy requires concurrent oral administration of an osmotic laxative like polyethylene glycol (PEG) and sometimes lactulose. PEG is pretty benign, but lactulose can cause abdominal cramping and flatulence, hence its status as second-choice treatment.
And, like pretty much every opioid, morphine causes drowsiness and difficulty concentrating. This was particularly frustrating for one of my patients, who was an avid reader. He said he could only keep focus in reading the newspaper and even then, usually just one article at a time. Not fun.
In-patient morphine therapy itself is very unlikely to leave the patient with an opioid addiction. In fact, many patients with a PRN self-administering device are reluctant to push that button. The ones who are usually are dealing with psychological difficulties or trauma. like the one young guy (late 30s) in ICU who was recovering from a colectomy and now faced a lifetime wearing a colostomy bag.
He wouldn’t even look at his stoma. Refused to. And even in his somewhat incapacitated state, he was vigilant about receiving his scheduled morphine dosage. I can’t blame him. That’s hard news to face and he just wasn’t ready for it. I’m not sure I would be, either.
