Small meals, reduced roughage, eating early in the day or when best tolerated.
Ensure Plus/Fortisip.
Analgesia
Paracetamol PO QID. (IV Paracetamol rather than PR can be used short term if oral tablets are not tolerated.)
Morphine subcut via regular bolus doses or by continuous infusion – oral morphine is unlikely to be absorbed.
Antiemetics
Haloperidol (via regular subcut bolus doses or by continuous infusion).
Cyclizine(via subcut infusion).
Metoclopramide-contraindicated in gastric outlet obstruction and complete high bowel obstruction (via regular subcut boluses or infusion).
Nozinan (via regular subcut boluses or infusion).
Anticholinergics
Antispasmodic (i.e. analgesic) and antisecretory (i.e. reduces nausea and vomiting) properties.
Hyoscine butylbromide (Buscopan™) 10 – 20 mg subcut q8h prn can be used for colicky pain.
Buscopan™ via subcut infusion (40-120 mg/24 hours) is standard treatment for established and irreversible obstruction. Must not be used in conjunction with metoclopramide.
Steroids
May have a role in reducing peri-tumour oedema and thus reversing obstruction – evidence is anecdotal. Often used intravenously for trial period.
Well established role when symptoms not controlled with opioids, antiemetics and anticholinergics. Evidence also exists for use in acute management of bowel obstruction but its use is restricted by cost.
Also has a role in the management of fistulae.
200-600 mcg/24 hours subcut.
Information about this Canterbury DHB document (4105):