Morphine hydrochloride hydrate

Manufactured by Takeda Pharmaceuticals

Sourced in Japan

Morphine hydrochloride hydrate is a chemical compound that is commonly used as a raw material in the pharmaceutical industry. It is a crystalline solid that is soluble in water and has a chemical formula of C₁₇H₁₉NO₃·HCl·xH₂O. The compound is a salt of the alkaloid morphine, which is derived from the opium poppy plant. Morphine hydrochloride hydrate is a controlled substance and its use is regulated due to its potential for abuse and addiction.

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Lab products found in correlation

Anapeine, by AstraZeneca (4 mentions) Bosmin, by Daiichi Sankyo (3 mentions) Adefuroniczupo, by Teva Pharmaceuticals (2 mentions) Sol mercort, by Fujifilm (2 mentions) Solu medrol, by Pfizer (1 mentions)

4 protocols using morphine hydrochloride hydrate

Periarticular Injection Comparative Efficacy

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We used a control solution for periarticular injection which
contained ropivacaine, morphine, epinephrine, and ketoprofen without
corticosteroid, and compared its effect with that of a periarticular
injection solution which contained the same agents but with corticosteroid.
The corticosteroid solution consisted of methylprednisolone 40
mg (Sol Mercort, Fuji, Toyama, Japan) (1 mL), 7.5 mg/mL ropivacaine
(Anapeine, AstraZeneca, Osaka, Japan) (40 mL), 10 mg/mL morphine
hydrochloride hydrate (Takeda, Osaka, Japan) (0.8 mL), 1.0 mg/mL
epinephrine (Bosmin, Daiichi-Sankyo, Tokyo, Japan) (0.3 mL), 50
mg of ketoprofen (Capisten, Kissei, Matsumoto, Japan) (2.5 mL),
and normal saline (15.4 mL). Just before implantation of the prosthesis,
20 mL of the mixture was injected into the posterior capsule and
the posteromedial and posterolateral structures.² Small volumes of
the solution were injected into multiple sites with the knee in flexion.¹³ After implantation,
the remaining 40 mL of mixture was injected into the extensor mechanism,
synovium, anterior capsule, pes anserius, retinaculum, periosteum,
iliotibial band, and collateral ligaments.²The procedure for periarticular injection without corticosteroid
was identical to that for periarticular injection with corticosteroid
except that the injectable solution contained an equivalent volume
of normal saline.

Tsukada S., Wakui M, & Hoshino A. (2016). The impact of including corticosteroid in a periarticular injection for pain control after total knee arthroplasty: a double-blind randomised controlled trial. The Bone & Joint Journal, 98-B(2), 194-200.

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Multimodal Analgesia for Knee Arthroplasty

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All patients received intraoperative periarticular injections. As an intraoperative periarticular injection, methylprednisolone 80 mg (Sol Mercort; Fuji, Toyama, Japan) [2 mL], 7.5 mg/mL ropivacaine (Anapeine; AstraZeneca, Osaka, Japan) [40 mL], 10 mg/mL morphine hydrochloride hydrate (Takeda, Osaka, Japan) [1.0 mL], 1.0 mg/mL epinephrine (Bosmin; Daiichi-Sankyo, Tokyo, Japan) [0.6 mL], 50 mg of ketoprofen (Capisten; Kissei, Matsumoto, Japan) [2.5 mL], and normal saline [13.9 mL] were routinely injected in both groups. All patients received a non-steroidal anti-inflammatory drug (50 mg of flurbiprofen axetil, Ropion; Kaken, Tokyo, Japan) intravenously 1 h after returning to the ward, and non-steroidal anti-inflammatory drug (60 mg of loxoprofen, Surinofen; Aska, Tokyo, Japan) was administered orally three times a day from 1 day after surgery. As rescue analgesic medication, a 25 mg of diclofenac sodium suppository (Adefuroniczupo; Teva, Nagoya, Japan) was used. No narcotic pain medications were used in postoperative medication.

Iseki T., Tsukada S., Wakui M., Kurosaka K., Yoshiya S, & Tachibana T. (2021). Percutaneous periarticular analgesic injection at one day after simultaneous bilateral total knee arthroplasty: an open-label randomized control trial. Journal of Orthopaedic Surgery and Research, 16, 357.

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Multimodal Pain Management After TKA

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The pre- and postoperative medications were identical in both groups except for the percutaneous periarticular multi-drug injection at the day following TKA. We routinely performed intraoperative periarticular injection for the perioperative pain management. The multi-drug solution of the injection included methylprednisolone 40 mg (Sol Mercort; Fuji, Toyama, Japan) [1 mL] as corticosteroid, 7.5 mg/mL ropivacaine (Anapeine; AstraZeneca, Osaka, Japan) [40 mL] as local anesthetics, 10 mg/mL morphine hydrochloride hydrate (Takeda, Osaka, Japan) [0.8 mL] as opioid, 1.0 mg/mL epinephrine (Bosmin; Daiichi-Sankyo, Tokyo, Japan) [0.3 mL], and 50 mg of ketoprofen (Capisten; Kissei, Matsumoto, Japan) [2.5 mL] as non-steroidal anti-inflammatory drugs [4 (link), 5 (link)]. The solution was mixed with 15.4 mL of saline to a combined volume of 60 mL. Intravenous 50 mg of flurbiprofen axetil (Ropion; Kaken, Tokyo, Japan) was given 1 h after turning back to the hospital ward. From the day following TKA, oral 60 mg of loxoprofen (Surinofen; Aska, Tokyo, Japan) was given three times per day. Study protocol permitted 25 mg of diclofenac sodium suppository (Adefuroniczupo; Teva, Nagoya, Japan) as rescue therapy. Opioid usage was prohibited apart from the morphine hydrochloride hydrate contained in the intraoperative periarticular injection.

Iseki T., Tsukada S., Wakui M., Kurosaka K, & Yoshiya S. (2019). Percutaneous periarticular multi-drug injection at one day after total knee arthroplasty as a component of multimodal pain management: a randomized control trial. BMC Musculoskeletal Disorders, 20, 61.

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Periarticular Injection Timing in TKA

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The study treatments were superficial injection in the early stage of TKA or in the late stage of TKA. All patients received deep injection just prior to implantation of the prosthesis.
In the early stage periarticular injection group, the superficial injection was performed just after exposing the fascial layer (just prior to arthrotomy).
In the late-stage periarticular injection group, the superficial injection was performed after implantation while waiting for the cement to cure.
The solution for periarticular injection consisted of 7.5-mg/mL ropivacaine (Anapeine, AstraZeneca, Osaka, Japan) (40 mL), 10-mg/mL morphine hydrochloride hydrate (Takeda, Osaka, Japan) (0.8 mL), 40-mg/mL methylprednisolone (Solu-Medrol, Pfizer, Tokyo, Japan) (1 mL), 20-mg/mL ketoprofen (Capisten, Kissei, Matsumoto, Japan) (2.5 mL), 1.0-mg/mL epinephrine (Bosmin, Daiichi-Sankyo, Tokyo, Japan) (0.3 mL), and normal saline (15.4 mL) [22 (link), 23 (link)]. As superficial injection, 40 mL of solution was injected into the extensor mechanism, pes anserinus, retinaculum, and iliotibial band. As deep injection, 20 mL of the solution was injected into the posterior capsule and the posteromedial and posterolateral structures [22 (link), 23 (link)].

Tsukada S., Kurosaka K., Maeda T., Iida A., Nishino M, & Hirasawa N. (2018). Early stage periarticular injection during total knee arthroplasty may provide a better postoperative pain relief than late-stage periarticular injection: a randomized-controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy, 27(4), 1124-1131.

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