When initiating morphine sulfate for postoperative pain, which action is appropriate?

• A. Anticipate that the patient will begin to experience the effect of the morphine 15 minutes after the start of the infusion.
• B. Provide additional intermittent boluses of morphine sulfate if the patient experiences breakthrough pain.
• C. Complete the Critical-Care Pain Observation Tool scale 5 minutes after increasing the infusion rate each time.
• D. Begin the infusion at the lowest ordered dose and increase the rate every 30 minutes if the patient continues to have pain.

Answer: (B)

When starting morphine for postoperative pain, it’s important to address pain spikes promptly without waiting for the infusion to titrate. Providing additional intermittent boluses for breakthrough pain is the most effective way to control sudden increases in pain while the base infusion maintains steady analgesia. This approach allows rapid relief, helps prevent under-treatment, and avoids the risks of repeatedly increasing the infusion rate, which can lead to oversedation or respiratory depression. After giving a bolus, reassess the patient’s pain using an appropriate tool and determine whether further analgesia is needed or if broader changes to the infusion become necessary.