Effects of morphine on the human sphincter of Oddi.

Helm, James F.; Venu, Rama P.; Geenen, Joseph E.; Hogan, Walter J.; Dodds, W J; Toouli, James; Arndorfer, Ronald C.

doi:10.1136/gut.29.10.1402

Cited by 129 publications

(69 citation statements)

References 15 publications

(1 reference statement)

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“…Helm et al [8] reported that morphine and opioids have been shown to cause functional obstruction of common bile Table 6 Percentage distribution according to postoperative analgesic requirement duct and sphincter of Oddi spasm. Most patients are seen with the classic clinical picture of SOD with marked longterm improvement in symptoms after endoscopic sphincterotomy [9].…”

Section: Discussionmentioning

confidence: 99%

Perioperative Status and Complications in Opium Addicts in Western Rajasthan

et al. 2011

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Opium addiction is rampant in Western Rajasthan and probably has the highest number of opium addicts in the world. The study envisages upon the presentation, diagnosis and various postoperative complications in surgically ill opium addicts vis-à-vis non addicts. The study is purported to benefit clinicians dealing with opium addict patients. The prospective cohort study was conducted at Mahatma Gandhi Hospital, Jodhpur between December 2004 and February 2006 and included cohorts of 71 opium addict and 50 nonaddict patients admitted in various surgical wards. The study focused on presentation and the post-surgical complications encountered in these patients vis-à-vis others. The results thus obtained were evaluated statistically (mean±SD, SEM, two tailed t test, chi-square test), p value of <0.05 was considered as significant. A thorough comparative analysis revealed that opium addict patients had a significantly higher incidence of postoperative respiratory, cardiovascular, systemic and local complications. The requirement of analgesics and duration of hospital stay were also significantly higher as compared to control group. The work concludes that opium addicts suffer a much higher degree of postoperative morbidity as compared to non-addicts.

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Section: Discussionmentioning

confidence: 99%

Perioperative Status and Complications in Opium Addicts in Western Rajasthan

et al. 2011

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“…Their effects on the sphincter of Oddi have well been researched. Helm et al [11] studied the effect of morphine on SO using OSM during ERCP. In a small cumulative dose of 2.5-5 µg/kg, morphine increased the frequency of phasic contractions to a maximum of 10-12/min, but it did not affect the mean amplitude of phasic contractions and the mean SO basal pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Outflow of fluid from the CBD is reduced or arrested when (1) the frequency of phasic contractions increases sufficiently to compromise diastolic filling of the sphincter segment, (2) phasic contractions propagate retrograde or occur simultaneously along the sphincter segment, or (3) passive filling of the sphincter segment is prevented by a BPOS that exceeds the CBDP. Morphine could cause functional obstruction of the SO by all three of these mechanims [11] . OSM shows a diagnotic value for Oddi's sphincter dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Effects of narcotic analgesic drugs on human Oddi’s sphincter motility

Zhang²,

Jin³

et al. 2004

WJG

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AIM:To assess the effects of intramuscular analgesics (morphine, Ap-237, pethidine and tramadol) on human Oddi's sphincter motility with choledochoscope manometry. METHODS:A total of 70 patients having T tubes after cholecystectomy and choledochotomy were assessed by choledochoscope manometry. They were randomly divided into morphine group, Ap-237 group, pethidine group and tramadol group. Basal pressure of Oddi's sphincter (BPOS), amplitude of phasic contractions (SOCA), frequency of phasic contractions (SOF), duration of phasic contractions (SOD), duodenal pressure (DP) and common bile duct pressure (CBDP) were scored and analyzed. All narcotic analgesic drugs were administered intramuscularly. RESULTS:Levels of BPOS, SOCA and SOF were increased after injection of morphine and Ap-237 (P<0.05), level of CBDP was increased from 4.97±3.87 mmHg to 8.62±7.43 mmHg (10 min later) and 7.32±5.95 mmHg (20 min later) after injection of morphine (P<0.01). No apparent change occurred after intramuscular injection of pethidine. Level of BPOS was increased from 7.01±5.50 mmHg to 2.87±2.78 mmHg 10 min after injection of tramadol and SOCA was decreased from 63.34±35.29 mmHg to 45.90±27.86 mmHg (10 min later,P<0.05) and 35.97±24.30 (20 min later,P<0.01) after administration of tramadol. CONCLUSION:All these findings indicate that Oddi's sphincter manometry via choledochoscope is a practical and new way to study the dynamics of Oddi' s sphincter. The regular dose of morphine and Ap-237 could increase BPOS, SOF and SOCA. Morphine could increase the level of CBDP, demonstrating an excitatory effect on the sphincter of Oddi. Pethidine had no effect on Oddi's sphincter motility. Tramadol shows an inhibitory effect on the motility of the sphincter of Oddi and decreases levels of BPOS and SOCA.

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“…By using endoscopic manometry, which permits accurate evaluation of the activity of drugs on the sphincter of Oddi, 4±6 it had been demonstrated recently that intravenous application of various doses of morphine increases the sphincter of Oddi baseline pressure and its phasic contraction amplitude and frequency. 3,18,19 However, the synthetic opioid analgesics pethidine (syn. meperidine), buprenorphine and tramadol did not stimulate sphincter of Oddi motility in such a profound manner.…”

Section: Discussionmentioning

confidence: 99%

Tilidine does not affect human sphincter of Oddi motility—a randomized, controlled study

Wehrmann

Rausch

Seiler³

et al. 1997

Aliment Pharmacol Ther

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Aim: To investigate the effects of intravenous pentazocine and tilidine on sphincter of Oddi motility. Methods: Twenty patients with suspected sphincter of Oddi dysfunction were enrolled in a prospective, double‐blind study. Sphincter of Oddi motility was assessed by means of endoscopic manometry after injection of 0.9% saline, as well as after randomized dosing with either 30 mg pentazocine i.v. (n = 10) or 50 mg tilidine i.v. (n = 10). Results: Pentazocine significantly increased the sphincter of Oddi baseline pressure from 32 ± 21 mmHg (saline) to 41 ± 19 mmHg (P = 0.002), whereas tilidine did not alter the sphincter baseline pressure (34 ± 15 mmHg saline vs. 36 ± 16 mmHg tilidine, P = 0.16). Furthermore, pentazocine increased the phasic sphincter contraction amplitude (108 ± 16 mmHg saline vs. 121 ± 18 mmHg pentazocine, P = 0.004), but tilidine was without any effect (125 ± 24 mmHg saline vs. 125 ± 21 mmHg tilidine, P = 0.93). The phasic sphincter of Oddi contraction frequency and duration were not influenced either by pentazocine or by tilidine. Conclusion: In contrast to 30 mg of pentazocine, 50 mg of tilidine does not affect sphincter of Oddi motility. Therefore, tilidine can be used during endoscopic manometry and for analgesia in pancreatobiliary disease.

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Effects of morphine on the human sphincter of Oddi.

Cited by 129 publications

References 15 publications

Perioperative Status and Complications in Opium Addicts in Western Rajasthan

Perioperative Status and Complications in Opium Addicts in Western Rajasthan

Effects of narcotic analgesic drugs on human Oddi’s sphincter motility

Tilidine does not affect human sphincter of Oddi motility—a randomized, controlled study

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