Does Epidural Fentanyl Decrease the Efficacy of Epidural Morphine After Cesarean Delivery?

Vincent, Robert D.; Chestnut, D.H.; Choi, W. W.; Östman, Pontus L.; Bates, James N.

doi:10.1213/00000539-199205000-00007

Cited by 10 publications

(6 citation statements)

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“…Furthermore, our study showed that the overall incidences of nausea and vomiting were relatively low and did not differ significantly between the two genotypes, which was similar to previous reports. 5,30,31 Thus, the patient's pruritic condition was the principal side effect examined in the current study.…”

Section: Discussionmentioning

confidence: 96%

Human opioid μ‐receptor A118G polymorphism may protect against central pruritus by epidural morphine for post‐cesarean analgesia

Tsai

Fan

Yang

et al. 2010

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 96%

Human opioid μ‐receptor A118G polymorphism may protect against central pruritus by epidural morphine for post‐cesarean analgesia

Tsai

Fan

Yang

et al. 2010

Acta Anaesthesiol Scand

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“…50 Paradoxically, for reasons unknown, the epidural administration of opioids may decrease the incidence of perioperative nausea and vomiting. 51 Nausea and vomiting induced by intrathecal and epidural opioids are likely the result of cephalad migration of drug in cerebrospinal fluid and subsequent interaction with opioid receptors located in the area postrema. 39,52 Sensitization of the vestibular system to motion 53 and decreased gastric emptying34 produced by opioids may also play a role in nausea and vomiting induced by intrathecal and epidural opioids.…”

Section: Nausea and Vomitingmentioning

confidence: 99%

Side effects of intrathecal and epidural opioids

1995

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“…However, apparently there were some confounding factors with inadequate study design in patient selection to influence the genetic variation analysis for the severity and incidence of those side effects induced by morphine, since those patients in the study received intrathecal 0.1 mg morphine during spinal anesthesia first, then followed by IVPCA morphine for postoperative pain management. The underlying mechanisms for the incidence and severity of those side effects induced by neuroaxial or parenteral morphine were different, and those side effects did not have distinct proportional relationship with opioid dosage neither [30–33]. For example, the most common and severe side effect induced by intrathecal morphine could be pruritus, and the most common and severe side effect induced by intravenous morphine could be nausea or vomiting.…”

Section: Discussionmentioning

confidence: 99%

Polymorphism of μ-Opioid Receptor Gene (OPRM1:c.118A>G) Might Not Protect against or Enhance Morphine-Induced Nausea or Vomiting

Chen

Chen²,

Huang

et al. 2013

Pain Research and Treatment

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A cohort, double blind, and randomized study was conducted to investigate the effect of a single nucleotide polymorphism of the μ-opioid receptor at nucleotide position 118 (OPRM1:c.118A>G) on the association with the most common side effects (nausea or vomiting) induced by intravenous patient control analgesia (IVPCA) with morphine, including incidence and severity analysis. A total of 129 Taiwanese women undergoing gynecology surgery received IVPCA with pure morphine for postoperative pain relief. Blood samples were collected and sequenced with high resolution melting analysis to detect three different genotypes of OPRM1 (AA, AG, and GG). All candidates 24 h postoperatively will be interviewed to record the clinical phenotype with subjective complaints and objective observations. The genotyping after laboratory analysis showed that 56 women (43.4%) were AA, 57 (44.2%) were AG, and 16 (12.4%) were GG. The distribution of genotype did not violate Hardy-Weinberg equilibrium test. There was no significant difference neither between the severity and incidence of IVPCA morphine-induced side effects and genotype nor between the association between morphine consumption versus genotype. However, there was significant difference of the relation between morphine consumption and the severity and incidence of IVPCA morphine-induced nausea and vomiting. The genetic analysis for the severity and incidence of IVPCA morphine-induced nausea or vomiting showed no association between phenotype and genotype. It might imply that OPRM1:c.118A>G does not protect against IVPCA morphine-induced nausea or vomiting.

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Does Epidural Fentanyl Decrease the Efficacy of Epidural Morphine After Cesarean Delivery?

Cited by 10 publications

References 0 publications

Human opioid μ‐receptor A118G polymorphism may protect against central pruritus by epidural morphine for post‐cesarean analgesia

Human opioid μ‐receptor A118G polymorphism may protect against central pruritus by epidural morphine for post‐cesarean analgesia

Side effects of intrathecal and epidural opioids

Polymorphism of μ-Opioid Receptor Gene (OPRM1:c.118A>G) Might Not Protect against or Enhance Morphine-Induced Nausea or Vomiting

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