Effect of Physostigmine on Morphine-Induced Postoperative Pain and Somnolence

Abstract

The effects of physostigmine 1 mg i.v. were studied on the analgesia, sedation and reduction in respiratory rate induced by morphine 10 mg/60 kg i.v. in 10 patients recovering from surgery. Within 5-10 min, physostigmine abolished the somnolent effect of morphine and restored the respiratory rate to pre-drug values. Analgesia, assessed by an independent observer and by the patient was, if anything, increased by physostigmine. The analeptic effect of physostigmine lasted 40-60 min.

Study of anti-nociceptive potential of physostigmine and its combination with morphine in albino rats

“…Nemirovsky et al (1985,1988,1990), Yaksh et al (1985,1995), Gillberg et al (1986, 1989, 1990 1991), Gordh et al (1989) also reported antinociceptive effect of cholinomimetics and anticholinesterases in the experimental animal models. [16][17][18][19][20][21][22][23][24] The results of the present study indicated that …”

Antagonism of morphine-induced central respiratory depression by donepezil in the anesthetized rabbit

“…In the previous studies, some drugs and substances have been indicated as candidate antagonists for opiate-induced respiratory depression (Weinstock et al, 1980;1981;1982;Snir-Mor et al 1983;Willette et al, 1986;Elmalem et al, 1991;Berkenbosch et al, 1994;Ballanyi et al, 1997;Owen et al, 2000;Manzke et al, 2003;Lalley, 2004;. Among these candidates, physostigmine is the only clinically used drug that can pass the blood brain barrier, it is rapidly metabolized to eseroline and two other metabolites (Giacobini et al, 1987).…”

“…Numerous articles have proposed various candidates as antagonistic drugs for opiate-induced respiratory depression (Weinstock et al, 1980;Weinstock et al, 1981;Weinstock et al, 1982;Snir-Mor et al 1983;Willette et al, 1987;Elmalem et al, 1991;Berkenbosch et al, 1994;Ballanyi et al, 1997;Owen et al, 2000;Manzke et al, 2003;Lalley, 2004;. However, none of these have been applied to clinical practice thus far because most are experimental chemicals.…”

Postoperative opisthotonus and torticollis after fentanyl, enfiurane, and nitrous oxide

“…2~ Physostigmine has also reversed postoperative morphine-induced respiratory depression, without impairing analgesia, probably due to physostigmine's anticholinergic action in the medulla. 21 However, physostigmine did not alter morphine-induced respiratory depression in unpremedicated volunteers. 19 Excitatory CNS phenomena following general anaesthesia have been documented previously.…”