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Palliative Care

 

 

Pain

Opioid Side Effects:

Nausea/Vomiting:

Constipation:

  • Often exacerbated by dehydratation and inactivity.
  • All opioid prescriptions in children should therefore be accompanied by prophylactic stimulant and softening laxatives.

Sedation/ Drowsiness:

  • Most children will become drowsy in the first 24 - 48 hours of commencing or increasing the morphine therapy. This usually resolves spontaneously with no need to adjust the dose. 
  • Explaining this information to both, the child and the family in advance provides reassurance and decreases anxiety

Pruritus:

  • Generally responds to antihistamines
  • If it is persistent and affecting quality of life, opioid rotation should be considered

Myoclonus:

  • It can occur in patients receiving high doses of opioids or in-patients on long term opioid therapy due to accumulation of neurotoxic metabolites such as morphine 3-glucuronide.
  • Approaches that are used include benzodiazepines and opioid rotation. (13)

Urinary retention:

  • External bladder pressure, intermittent bladder catheterization or  opioid rotation are usually used.

Respiratory depression:

  • This is the most feared complication. Pain is a very effective stimulant to respiratory drive and apnea is highly unlikely if titration is carried out properly. (13)
  • Rarely occurs in children on the palliative care settings. Usually is more frequently seen in neonates due to longer opioid half life caused by immature enzyme systems (2).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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