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Managing pain in hospital

BMJ 1998; 316 doi: (Published 31 January 1998) Cite this as: BMJ 1998;316:395

Protocol must not take precedence over clinical judgment and compassion

  1. E L Lloyd, Consultant anaesthetista
  1. a Department of Anaesthetics, Western General NHS Trust, Edinburgh EH4 2XU
  2. b 19 Fairfield Park Road, Bath BA1 6JW
  3. c Child Health Department, Bath BA1 3QE

    Editor—Savage's personal experiences of the preoperative periods after dislocations of a prosthetic hip are an indictment of several aspects of current medical teaching in Britain.1 She is right in her comment about British doctors being frightened of opiates. There are two factors. The irrational fear is not of addiction but of respiratory depression. The general medical and nursing population does not seem to appreciate that apnoea does not suddenly develop when an opiate threshold has been reached but that the respiratory rate slows gradually with increasing doses of opiate. My prescription for 10 mg morphine intramuscularly to be given every one to four hours as required for postoperative analgesia was regularly changed by the resident doctor, without my being informed, to 10 mg morphine four hourly, at the instigation of one night …

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