Morphine Concentration in Brain and Spinal Cord after Subarachnoid Injection in Baboons

Ma, Gregory; Jg, Brock-Utne; S, Bux; Jw, Downing

doi:10.1213/00000539-198509000-00013

Cited by 28 publications

(9 citation statements)

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“…69 Centrally mediated side effects of IT opioids include late respiratory depression, pruritis, nausea, vomiting, urinary retention, sedation, constipation, edema, weight gain, excessive perspiration, memory or mood changes, and headache. 52,70 Intrathecal local anesthetics. Intrathecal bupivacaine has been used in combination with morphine for better pain control in both malignant and nonmalignant pain.…”

Section: After Carementioning

confidence: 99%

Intrathecal Drug Delivery System (IDDS) for Cancer Pain Management

Upadhyay

Mallick

2011

Am J Hosp Palliat Care

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Cancer pain remains undertreated and a significant number of patients with cancer pain die from severe untreated pain. With increasing survival rate in cancer, the prevalence of cancer pain is also increasing in number. Though majority of patients with cancer pain can be effectively treated with conventional medical management, still a significant portion of patients required some form of interventional pain management techniques. Among the interventional techniques, intrathecal drug delivery is increasingly used in cancer pain management. Our objective of this article is to review literatures and clinical studies on intrathecal drug delivery system (IDDS) in cancer pain management and to provide updates on its use, precautions, contraindications, side effects and its management, socioeconomic consideration, and management of IDDS in difficult or uncommon situations.

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Section: After Carementioning

confidence: 99%

Intrathecal Drug Delivery System (IDDS) for Cancer Pain Management

Upadhyay

Mallick

2011

Am J Hosp Palliat Care

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“…The early respiratory depression seen during the first hours after epidural administration appears to be related to the plasma concentration of morphine (14). Late respiratory depression, on the other hand, is thought to be the result of rostra1 spread of morphine within the CSF (15)(16)(17), resulting in high morphine concentration in the CSF surrounding the brain stem and midbrain.…”

Section: Discussionmentioning

confidence: 99%

Pupillary Diameter and Ventilatory CO2 Sensitivity after Epidural Morphine and Buprenorphine in Volunteers

Ravnborg

Jensen

et al. 1987

Anesthesia & Analgesia

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N-H, HOLK IK. Pupillary diameter and ventilatory C 0 2 sensitivity after epidural morphine and buprenorphine in volunteers. Anesth Analg 1987;66:847-51.The aim of this study was to correlate pupillary diameter with respiratory depression for 20 hr after epidural administration of morphine or buprenorphine. Pupillary diameter and the ventilatory sensitivity to CO, were measured in six healthy volunteers at various times (0, 0.5, 1 , 2, 3, 4, 6 , 8, 10, 12, and 20 hr) in two sessions, separated by at least 1 week, at which either epidural morphine, 4 mg, or epidural buprenorphine, 0.15 mg, was administered randomly in a double-blind manner. Three of the six volunteers received 0.3 mg buprenorphine epidurally in a third session. Pupillary diameter was measured with a modified Essilor pupillometer. The ventilatory CO, sensitivity was measured by a modified Read rebreathing technique. The ventilatory parameters measured were mouth occlusion pressure during the first 0.1 sec of inspiration (Po,l), end-tidal CO, PET^^^), tidal volume (VT) and respiratory rate (RR). Slopes of the h e a r regression lines (P,,/CO,, vT/coz, VEICO,, and RRICO,) and the intercept values of the regression lines and PET^^^ = 7.2 kPa (Po 1:7.2, V~: 7 . 2 , V~: 7 . 2 , and RR: 7.2) were calculated. Pupillary diameter after epidural morphine was smallest at the second hour and had returned to normal after eight hours. After epidural buprenorphine there were two periods of miosis, one at 1-3 hr, the other at 10 hr. With epidural morphine, a statistically significant correlation (P < 0.05) was found between pupillary diameter and VEICO~, V~: 7 . 2 , P,,:7.2, and V~: 7 . 2 . With epidural buprenorphine 0.15 mg a significant correlation was found between pupillary diameter and V~: 7 . 2 and Po ,:7.2. With epidural buprenorphine 0.3 mg the correlations between pupillary diameter and VE:Co,, k 7 . 2 , and P0.,:7.2 were significant. The results indicate that the neural control of respiration and of pupillary diameter is influenced synchronously by epidural opioids and that the pupillary response may serve as an indicator of respiratory depression.The dose-dependent pupillary constriction produced in humans by opioids is easily observed and quantified. The possibility of correlation between miosis and respiratory depression during analgesic therapy with opioids has not been evaluated. With the introduction of epidural opioid administration, the necessity to monitor respiration has been accentuated because of late respiratory depression. Several reports on life-threatening late respiratory depression (1,2) have restricted the use of epidural opioid administration in pain treatment.The aim of this study was to measure changes in pupillary diameter after epidural administration of

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“…We can sympathise that only 5.9% of respondents regularly add intrathecal morphine to their spinal solution as the risk of delayed respiratory depression is of concern in an elderly population returning to a general surgical ward. As a hydrophilic opioid, morphine is retained within the central nervous system after intrathecal injection [2] with a maximum concentrated in the medulla oblongata after 6 h [3]. Slow cephalad migration of morphine within the cerebrospinal fluid is thought to lead to late depression of the respiratory centres on the floor of the fourth ventricle [4], the true incidence of which, is unknown [5].…”

Section: A Replymentioning

confidence: 99%