Effects of intrathecal morphine and spinal anaesthesia on sympathetic nerve activity in humans

KirnÖoU, K.; Lundin, S.; Elam, Mikael

doi:10.1111/j.1399-6576.1993.tb03598.x

Cited by 20 publications

(7 citation statements)

References 22 publications

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“…The adjuvant use of neuroaxial opioids allows for lower doses of local anesthetics to be used. This enhancement of analgesia comes without additive motor blockade or hypotension, with the exception of meperidine, which, because of its unique local anesthetic-like properties, may result in motor block, hypotension, or loss of proprioception [9]. Because CSE allows for ambulation of the parturient, it has been called the "walking epidural".…”

Section: Cse For Labor Analgesiamentioning

confidence: 99%

Recent advances in obstetric anesthesia

Farragher

Datta

2003

Journal of Anesthesia

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The low-dose technique of combined spinal/epidural analgesia is to be welcomed in obstetrics. Its merits include rapid onset of analgesia, with the flexibility of an epidural technique, and high maternal satisfaction. It is a safe and effective technique. Pulse oximetry should be employed when using intrathecal opioids. Commercially available combined-needle devices may make this technique more attractive to users. The role of spinal anesthesia for emergency cesarean section in severe preeclampsia has been reevaluated recently. We consider it a feasible option for those severely preeclamptic women requiring urgent cesarean section who do not have an epidural catheter in place. The choice of anesthetic technique for this patient population should be made on clinical judgment and not on anticipated hemodynamic changes. Spinal anaesthesia for cesarean section is associated with hypotension; however, certain interventions may reduce the incidence and severity of the hypotension. An increase in cardiac output appears to be key in attenuating the hypotensive response to spinal anesthesia. Colloids have exhibited most success in this regard. At our institution, we do not delay spinal anesthesia for urgent cesarean section in order to administer a predetermined volume of fluid; in such cases, we simultaneously administer a fluid preload and spinal anesthesia. Recent studies regarding the use of cell savers for blood conservation in obstetrics are based on small numbers of patients. These studies show great promise, particularly with the modern emphasis on avoiding blood transfusion, which can be massive in this usually young patient population.

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Section: Cse For Labor Analgesiamentioning

confidence: 99%

Recent advances in obstetric anesthesia

Farragher

Datta

2003

Journal of Anesthesia

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“…However, it has been reported that in humans sympathetic nerve activity remains unchanged after intrathecal morphine. 52 Norris et al reported a similar effect on systolic blood pressure by both labor epidural and CSE. 26 He reported 7.9% incidence of hypotension after intrathecal sufentanil, a much lower incidence than the other studies.…”

Section: Hypotensionmentioning

confidence: 85%

Progress in analgesia for labor: focus on neuraxial blocks

Ranasinghe

Birnbach

2009

IJWH

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Neuraxial analgesia is widely accepted as the most effective and the least depressant method of providing pain relief in labor. Over the last several decades neuraxial labor analgesia techniques and medications have progressed to the point now where they provide high quality pain relief with minimal side effects to both the mother and the fetus while maximizing the maternal autonomy possible for the parturient receiving neuraxial analgesia. The introduction of the combined spinal epidural technique for labor has allowed for the rapid onset of analgesia with minimal motor blockade, therefore allowing the comfortable parturient to ambulate. Patient-controlled epidural analgesia techniques have evolved to allow for more flexible analgesia that is tailored to the individual needs of the parturient and effective throughout the different phases of labor. Computer integrated systems have been studied to provide seamless analgesia from induction of neuraxial block to delivery. New adjuvant drugs that improve the effectiveness of neuraxial labor analgesia while decreasing the side effects that may occur due to high dose of a single drug are likely to be added to future labor analgesia practice. Bupivacaine still remains a popular choice of local anesthetic for labor analgesia. New local anesthetics with less cardiotoxicity have been introduced, but their cost effectiveness in the current labor analgesia practice has been questioned.

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“…Another mechanism that could contribute to the rise in arterial blood pressure with morphine is a direct increase in central sympathetic outflow. To our knowledge, only one study has previously examined the effect of morphine on resting MSNA in humans (13). These authors reported that baseline MSNA did not change with intrathecal administration of morphine (0.4 mg) with no change in arterial blood pressure or heart rate.…”

Section: Discussionmentioning

confidence: 99%

“…Because activation of the sympathoadrenal (11) and renin-angiotensin (1) systems has been suggested to contribute to increases in resting arterial blood pressure with morphine, it is possible that central sympathetic outflow is increased. To our knowledge, only one study has examined the effects of morphine on muscle sympathetic nerve activity (MSNA) at rest (13). Kirno et al (13) report no change in either MSNA or arterial blood pressure.…”

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confidence: 99%

Effect of morphine on sympathetic nerve activity in humans

Carter

Sauder

Ray

2002

Journal of Applied Physiology

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There are conflicting reports for the role of endogenous opioids on sympathetic and cardiovascular responses to exercise in humans. A number of studies have utilized naloxone (an opioid-receptor antagonist) to investigate the effect of opioids during exercise. In the present study, we examined the effect of morphine (an opioid-receptor agonist) on sympathetic and cardiovascular responses at rest and during isometric handgrip (IHG). Eleven subjects performed 2 min of IHG (30% maximum) followed by 2 min of postexercise muscle ischemia (PEMI) before and after systemic infusion of morphine (0.075 mg/kg loading dose + 1 mg/h maintenance) or placebo (saline) in double-blinded experiments on separate days. Morphine increased resting muscle sympathetic nerve activity (MSNA; 17 +/- 2 to 22 +/- 2 bursts/min; P < 0.01) and increased mean arterial pressure (MAP; 87 +/- 2 to 91 +/- 2 mmHg; P < 0.02), but it decreased heart rate (HR; 61 +/- 4 to 59 +/- 3; P < 0.01). However, IHG elicited similar increases for MSNA, MAP, and HR between the control and morphine trial (drug x exercise interaction = not significant). Moreover, responses to PEMI were not different. Placebo had no effect on resting, IHG, and PEMI responses. We conclude that morphine modulates cardiovascular and sympathetic responses at rest but not during isometric exercise.

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Effects of intrathecal morphine and spinal anaesthesia on sympathetic nerve activity in humans

Cited by 20 publications

References 22 publications

Recent advances in obstetric anesthesia

Recent advances in obstetric anesthesia

Progress in analgesia for labor: focus on neuraxial blocks

Effect of morphine on sympathetic nerve activity in humans

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