Briefing Note - extended release morphine sulphate for epidural injection (Depodur)

SMC did not accept extended release epidural morphine (EREM) for the relief of postoperative pain following major orthopaedic, abdominal or pelvic surgery.

• Major surgery can result in the patient experiencing significant pain and therefore requiring pain relief medication.
• The epidural space is the area outside the spinal cord but inside the vertebral canal of the spinal column. The epidural space is used for drug administration as it allows the drug to be injected near to the spinal cord and the nerves surrounding it and therefore helps to relieve the pain caused by surgery. This particular product is described as an extended-release injection as the pain relief lasts for about 48 hours after one dose has been given.
• In some studies, EREM was shown to give better pain relief than a single dose of a shortacting form of an epidural opioid drug (strong pain killer). However, evidence for efficacy was obtained from studies that do not reflect current practice for epidural analgesia in NHSScotland.
• EREM was generally well tolerated with side effects similar to short-acting epidural morphine, though itch and difficulties with urine production occurred more often with the higher doses of EREM.
• SMC did not accept EREM for use within NHSScotland because a number of weaknesses in the case submitted by the manufacturer meant that value for money was not demonstrated. The key weakness was the inclusion of savings from reduced time in a high dependency unit and reduced length of hospital stay associated with EREM. These savings were estimated from studies conducted in other countries, but are unlikely to be realised in Scottish practice.