Opioid-sparing Effects of a Low-dose Infusion of Naloxone in Patient-administered Morphine Sulfate 

Abstract

Naloxone is effective in preventing PCA opioid-related side effects. Naloxone infusion at 0.25 microg x kg(-1) x h(-1) not only attenuates these side effects but appears to reduce postoperative (beyond 4-8 h) opioid requirements. This dosing regimen can be prepared with 400 microg naloxone in 1,000 ml crystalloid given in 24 h to a patient weighing 70 kg.

Subcutaneous naloxone for the prevention of intrathecal morphine induced pruritus in elective Caesarean delivery*

“…Naloxone was chosen from the other opioid antagonists available for multiple reasons: availability, cost, safety profile in breast feeding and potential intrinsic analgesic properties when given in low doses [16,21,22].…”

“…(420 lg.day )1 in a 70-kg subject) has been shown to reduce pruritus significantly and possibly decrease analgesic requirements in patients undergoing abdominal hysterectomy who received intravenous morphine patient-controlled analgesia [16]. Doses of > 1 lg.kg…”

“…Due to the short duration of action when administered intravenously, studies have involved intravenous regimes of naloxone infusions with or without loading doses [6,11,14,16]. The need for possible infusion pump technology, extra nursing resources, and patient inconvenience are some of the obvious limitations of an intravenous technique.…”

Compatibility and Stability of Morphine Sulphate and Naloxone Hydrochloride in 0.9% Sodium Chloride for Injection

“…This drug has been reported to reduce the incidence of opioid-induced pruritus among adult patients receiving morphine by postoperative PCA, from 55% with placebo to 25% with naloxone. 27 No respiratory depression was observed with naloxone, and no differences in respiratory rate, sedation scores, blood pressure, heart rate, or oxygen saturation between naloxone and placebo groups were reported. 27 In children, naloxone "piggy-backed" into patients' morphine PCA infusions reduced the incidence of pruritus from 77% in the placebo group to 20% in the naloxone group.…”

“…27 No respiratory depression was observed with naloxone, and no differences in respiratory rate, sedation scores, blood pressure, heart rate, or oxygen saturation between naloxone and placebo groups were reported. 27 In children, naloxone "piggy-backed" into patients' morphine PCA infusions reduced the incidence of pruritus from 77% in the placebo group to 20% in the naloxone group. 9 In an underpowered pilot study (n = 16 patients) examining co-infusion of morphine with low-dose (0.25 µg/kg per hour) or high-dose (1 µg/kg per hour) naloxone, trends suggested that the high-dose group had a lower incidence of pruritus than the low-dose group.…”