title: Barriers to the use of morphine for the management of severe postoperative pain - a before and after study.
abstract: OBJECTIVE
  To reduce the number of patients experiencing severe postoperative pain by prescribing 10 mg Morphine either as oral solution or by IM injection as an alternative to Tramadol Hydrochloride in an analgesic protocol.
  
  
  METHODS
  Patients who received in-patient oral and maxillofacial surgery under general anaesthesia were included. Complex intervention analgesic protocols were developed including staff education, patient educations and analgesic protocols. 80 patients were treated under the original protocol (tramadol hydrochloride for pain unmanaged by other drugs in protocol) over 4 months. 75 patients were treated under the second protocol (oral or intravenous morphine for pain unmanaged by other drugs in protocol). Patient perceptions to their pain management were then assessed.
  
  
  RESULTS
  Proportion of patients reporting 'no pain' increased from 5% of 80 patients to 28% of 75 patients (p < 0.001). Report of severe pain reduced from 37% to 31% and not significant. Pain duration reduced from 18% to 12% for 75-100% time from surgery to discharge and not significant. Staff used protocols for 96% patients. Nurses provided patient information leaflets for 85%-80% patients. Nearly all patients (96% and 95%) reported overall satisfaction with their pain management.
  
  
  CONCLUSIONS
  The use of morphine given orally or my IM injection rather than tramadol was associated with a significant increase in the number of patients reporting 'no pain'. However the number of patients experiencing severe pain was not significantly reduced. Despite this, most patients reported high levels of satisfaction which suggested that satisfaction questionnaires should not be used in isolation. Most patients received morphine orally rather than by IM injection but the oral dose may not have been high enough in this study.
authors: The University of Manchester, School of Dentistry, Coupland 3 Building, Coupland Street, Manchester M13 9PL, United Kingdom.
authors: P
authors: P
authors: Coulthard
authors: The University of Manchester, School of Dentistry, Coupland 3 Building, Coupland Street, Manchester M13 9PL, United Kingdom. Electronic address: Neil.Patel@cmft.nhs.uk.
authors: N
authors: N
authors: Patel
authors: The University of Manchester, School of Dentistry, Coupland 3 Building, Coupland Street, Manchester M13 9PL, United Kingdom.
authors: E
authors: E
authors: Bailey
authors: Division of Surgery, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom.
authors: D
authors: D
authors: Armstrong
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007880:Legislation, Drug; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D014147:Tramadol / Q000008:administration & dosage; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol; D009020:Morphine
keywords: Morphine; Pain; Postoperative pain