IM Morphine

MissJessica,RN · Jun 7, 2011

We have a MD that only orders IM morphine at the hospital I work at. Not sure of the logic when we have IV's--I have heard that IM injections of morphine last longer than IV (however, I'm not sure if that's true)....and we hardly even see it in pill form unless its a chronic pain patient that was on it prior to admission. I never saw it when I worked in long-term care in any form so I can't help there.

DLS_PMHNP, MSN, RN, NP · Jun 7, 2011

I could see it ordered sub-q, but not IM. Unless the resident has very little body fat

NotFlo · Jun 7, 2011

We have one patient with very special circumstances that gets IM Dilauded for routine pain control. No one has IM morphine ordered for routine pain control when there are other options available though.

meandragonbrett · Jun 7, 2011

One of our spine surgeons orders 15mg Morphine with 12.5mg Phenergan IM for pain control post op q4h. It apparently works fantastically for his patient population.

Hospice Nurse LPN, BSN, RN · Jun 7, 2011

Do any of you use IM Morphine for routine pain control? We have a new doc and he's ordered IM Morphine for a resident. I asked why not MS Contin for long acting with MSIR or roxanol for break through. Apparently the resident requested IM . Very strange.

Strange, indeed. Roxanol works so good for breakthrough pain. I can't imagine anyone REQUESTING an injection.

GHGoonette, BSN, RN · Jun 7, 2011

Speaking purely from a PACU point of view, the accepted best practice is to titrate morphine/pethidine (according to the anaesthetist's preference) and administer IV until the pain is under control. Previously, analgesics were either given intra operatively or prescribed IM for post-op pain control. I habitually gave it as prescribed, especially if I knew it was a very painful procedure, with excellent results. Sure, it doesn't work as quickly as IV administration, but the effects are indeed longer lasting. One anaesthetist argued that the substance becomes "compartmentalized" in the muscle, with a tendency to be released at a later stage, causing excessively high blood levels of the substance.

Personally, if I'm offered the option of administering IM, I take it, and just keep the pt in PACU a bit longer to observe respiratory rate and assess pain levels. Of course, it's a different kettle of fish in the wards. I'd suggest if the pt and/or the Dr insist on IM administration, it might be a good idea to keep the pt on a pulse oximeter and monitor for respiratory suppression.

360jRN · Jun 7, 2011

In my opinion, it has to do more with physician preference and comfort level with said med than effectiveness, route, etc. I work with a physician in our ER who comes from a surgical background and that's his favorite med, Morphine. If I give one IM injection I give 10 everytime he works.

CapeCodMermaid, RN · Jun 7, 2011

Speaking purely from a PACU point of view, the accepted best practice is to titrate morphine/pethidine (according to the anaesthetist's preference) and administer IV until the pain is under control. Previously, analgesics were either given intra operatively or prescribed IM for post-op pain control. I habitually gave it as prescribed, especially if I knew it was a very painful procedure, with excellent results. Sure, it doesn't work as quickly as IV administration, but the effects are indeed longer lasting. One anaesthetist argued that the substance becomes "compartmentalized" in the muscle, with a tendency to be released at a later stage, causing excessively high blood levels of the substance.
Personally, if I'm offered the option of administering IM, I take it, and just keep the pt in PACU a bit longer to observe respiratory rate and assess pain levels. Of course, it's a different kettle of fish in the wards. I'd suggest if the pt and/or the Dr insist on IM administration, it might be a good idea to keep the pt on a pulse oximeter and monitor for respiratory suppression.

This is long term care. I don't have the staff to monitor ONE patient that closely ...on the overnight shift, the nurses have 40 patients.

CoffeeRTC, BSN, RN · Jun 7, 2011

I haven't given an IM shot for pain in years! We have sub acute post op day 2 or 3 residents, but they have IV meds for severe pain or po.

Chronic pain..they are put on a patch, or long acting po's with break thru meds.

I've had a few residents ask for it since "it is the only thing that works" but I work to get different and effective pain relief in other forms.

CompleteUnknown · Jun 7, 2011

One of our docs tends to order IM morphine for one of the residents who has intermittent severe pain. It works well for that particular resident. Years ago (feeling old, that's the second time I've said that tonight!), almost every post op patient had IM narcotics for pain relief 4th hourly PRN on the ward and that was in the days before pulse oximeters.

We usually give morphine SC but the orders often state "IMI or SCI". We don't routinely do more frequent vital sign monitoring following IM or SC morphine, it would depend on the individual resident and the circumstances.

GHGoonette, BSN, RN · Jun 7, 2011

This is long term care. I don't have the staff to monitor ONE patient that closely ...on the overnight shift, the nurses have 40 patients.

Seriously? you saying that your average LTC doesn't have one pulse oximeter on the premises? What do you do if you have patients with COPD or who are on BP meds? Many of the vitals monitors these days can measure temp, pulse, O2 and BP....