CNS Depression from Intrathecal Morphine

Davies, GE; Tolhurst‐Cleaver, C. L.; James, Terry L.

doi:10.1097/00000542-198003000-00022

Cited by 78 publications

(13 citation statements)

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“…Signs of efferent sympathetic block were absent and the fact that uterine contractions were not suppressed supports this assessment. Although none of our patients showed clinical signs of respiratory depression, a number of such cases have been reported by others (20, 12, 15,9). It is possible that this is related to the use of larger doses of opiates which in part may diffuse via the cerebrospinal fluid into the respiratory centers.…”

Section: Discussionmentioning

confidence: 48%

Variations in the effect of epidural morphine in gynecological and obstetric patients

Niv¹,

Rudick²,

Chayen³

et al. 1983

Acta Obstet Gynecol Scand

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A prospective study was performed on the effect of epidural morphine (2 mg in 10 ml of saline) in three groups of patients: (1) following gynecological operations, 60; (2) following cesarean section, 120; (3) patients in active labor, 30. Pain relief in the first group was uniformly and almost invariably complete for up to 24 hours. In the second group spasmodic visceral pain was felt after about 10 hours, relieved by light analgesics. The wound was not painful. In the third group only hypoalgesia was obtained during labor, but if an episiotomy was done, the pain in the perineum was relieved. Few side effects were observed: urinary retention, vomiting, and non-segmental itching. Neither motor nor sympathetic block were noted. The somatic effect of epidural morphine was reliable and uniform, whereas visceral pain was poorly affected. The side effects cause relatively little disturbance at the dose used.

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Section: Discussionmentioning

confidence: 48%

Variations in the effect of epidural morphine in gynecological and obstetric patients

Niv¹,

Rudick²,

Chayen³

et al. 1983

Acta Obstet Gynecol Scand

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“…an ellux of excess morphine from the spinal subarachnoid space to the ventricular system. Recently, several cases of "unexplained" or delayed respiratory depression have been reported by other investigators after intrathecal and epidural administration of narcotics (SCOTT & MCCLURE 1979, GLYNN et al 1979, LIOLIOS & HART-MANN ANDERSEN 1979, CHRISTENSEN 1980, DAVIES et al 1980, REIZ & WESTBERC 1980. Common to all these reports is the efficient counteraction of the respiratory depression by naloxone, which was also the case in our patient.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Epidural Morphine and Epidural Bupivacaine for Postoperative Pain Relief

Modig

Paalzow

1981

Acta Anaesthesiol Scand

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In 32 patients subjected to total hip replacement, postoperative pain relief was achieved by random treatment with either 5 mg of morphine in 10 ml of saline (n = 15) or 6-8 ml of 0.5% bupivacaine with epinephrine (n = 17), both drugs administered by the lumbar epidural route. In an additional group of 10 patients, post-traumatic thoracic or post-operative abdominal pain was relieved first by 4-6 ml of 0.5% bupivacaine with epinephrine and subsequently by 5 mg of morphine in 10 ml of saline, both drugs being administered by the thoracic epidural route. The duration of analgesia was significantly longer, on average, with morphine (28 h) than with bupivacaine (4.3 h) when the drugs were given by the lumbar route. Thoracic administration of morphine also resulted in a significantly longer duration of pain relief (on average 9.8 h) than that of bupivacaine (3.8 h). Morphine gave satisfactory pain relief in all cases. It was not associated with motor block, loss of sensitivity to temperature, touch, or pin-prick, or any signs of sympathetic block, as was the case with epidural bupivacaine. Plasma concentrations of morphine were not detectable 8 h after injection, though the patients still had pain relief. One case of delayed severe respiratory depression occurred 6 h after morphine injection via the thoracic route. Epidural morphine analgesia should therefore be reserved for patients in whom continual surveillance is possible, at least until more is known about the pharmacokinetics of narcotics in the epidural and subarachnoid space.

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“…A combination of these agents may offer a theoretical advantage for postoperative pain relief.) 3 Postoperative analgesia by epidural opioids has been tested in numerous studies and is now widely used in clinical practice. Although morphine has been the most commonly used opioid, ircan cause side effects such as: pruritus, nausea, vomiting, urinary retention, and respiratory depression.…”

Section: Discussionmentioning

confidence: 99%

Epidural administered buprenorphine in the perioperative period

1996

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Epidural administered buprenorphine in the perioperative periodPurpose: To study the effect of epidural buprenorphine on minimum alveolar concentration (MAC) Accepted for publication l lth May, 1996. Epidural administration of morphine has been used extensively since the initial positive report. I However, compared with the intrathecal route, epidural administration of opioids is complicated by pharmacokinetic aspects related to dural penetration, fat deposition, and systemic absorption. The effect of epidural opioids and analgesics on the onset and duration of analgesia is considered to be strongly correlated with its lipophilicity and hydrophilicity. 2 The pharmacokinetic behaviour of the agents also influences the incidence of undesirable side effects, particularly early and late respiratory depression, which is often observed with epidural administration of morphine. 3-5 CAN J ANAESTH 1996 / 43:9 / pp907-13

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CNS Depression from Intrathecal Morphine

Cited by 78 publications

References 0 publications

Variations in the effect of epidural morphine in gynecological and obstetric patients

Variations in the effect of epidural morphine in gynecological and obstetric patients

A Comparison of Epidural Morphine and Epidural Bupivacaine for Postoperative Pain Relief

Epidural administered buprenorphine in the perioperative period

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