Article Text

Download PDFPDF
Comparison of two techniques (intermittent intravenous bolus morphine vs. morphine infusion) for analgesic titration in patients who had advanced cancer with severe pain: a prospective randomised study
  1. Vinod Kumar1,
  2. Prashant Sirohiya2,
  3. Rakesh Garg1,
  4. Nishkarsh Gupta1,
  5. Sachidanand Jee Bharti1,
  6. Thirumurthy Velpandian3,
  7. Seema Mishra1 and
  8. Sushma Bhatnagar1
  1. 1 Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
  2. 2 Anaesthesia, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
  3. 3 Department of Ocular Pharmacology, Dr Rajendra Prasad Centre for Opthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Vinod Kumar, Department of Onco-Anaesthesia and Palliative medicine, All India Institute of Medical Sciences, New Delhi 110029, India; vkchanpadia{at}


Objective To compare the analgesic efficacy of two techniques of morphine titration (intermittent intravenous bolus vs infusion) by calculating rescue dosage in a day at 1 week after analgesic titration.

Methods One hundred and forty cancer patients were randomised into two groups. In group 1, intravenous morphine 1.5 mg bolus given every 10 min until Numerical Rating Scale (NRS) pain score <4 is achieved. Total intravenous dose converted to oral dose (1:1) and administered every 4 hours. In group 2, intravenous bolus morphine 0.05 mg/kg body weight administered followed by 0.025 mg/kg/hour intravenous infusion. The NRS pain score was recorded every 10 min but infusion rate was titrated every 30 min if required. The infusion rate of morphine was doubled if the pain score was unchanged and increased to 50% when NRS was between 4 and baseline. If NRS<4, then infusion at same rate was continued. Once the NRS<4 for two consecutive hours, total intravenous dose for 24 hours was calculated and converted to oral morphine in a ratio of 1:3 and divided into six doses given over 24 hours. For rescue (pain score ≥4) analgesia, one-sixth of the total daily oral dose was prescribed. The primary outcome of this study was to note the number of rescue doses of oral morphine in a day at 1 week.

Results The rescue dosage in a day at 1-week post discharge from the palliative care unit was significantly higher in group 1 as compared with group 2.

Conclusion Intravenous infusion morphine may be a better analgesic titration technique for analgesia in patients with advanced cancer.

Trial registration number CTRI/2018/04/013369.

  • cancer
  • pharmacology
  • symptoms and symptom management
  • supportive care
  • pain

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • Contributors VK, PS, RG, NG, SJB, TV, SM and SB contributed to study design and implementation of the study and analysis of the dataset, provided critical feedback and revisions on the manuscript, and approved the final version for submission.

  • Funding Received grant for this intramural project from AIIMS Research Section vide memorundum no.- F.No.8-414/A414/2016/RS.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.