After 6 melts in succession were not really quashing the pain, we contacted the nurse on call who came back with switching to 30mg of oramorph and increasing the fentanyl patch to 125mcg. Oramorph is no stronger than the melts necessarily but acts in a different way, in case the melts are no longer effective.
After the oramorph wasn't effective either an hour later, another call to the nurse allowed giving another 30mg. That only lasted a short while and so another 60mg was given. By 7.30pm he was ready to eat his battered sausage.
We're slightly nervous about the night. The registrar is suggesting boosting his dex for three days. If we have to give continued oramorph overnight we will be getting back to the nurse as they can call on an emergency pharmacist to make up a syringe driver with diamorphine. Hopefully that won't be necessary. Please pray.
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