Relationship between morphine responses and sphincter of Oddi motility in undefined biliary pain after cholecystectomy

Abstract

In 150 patients with undefined biliary pain after cholecystectomy, responses to morphine were compared with responses to morphine combined with neostigmine. The relationship between rises in plasma levels of aspartate aminotransferase (AST) after morphine or morphine-neostigmine and sphincter of Oddi motility as assessed by endoscopic manometry was also examined. When compared with morphine-neostigmine, patients given morphine alone showed a similar frequency (30% versus 33%) of increases in plasma levels of AST (greater than twice the upper limit of the reference range) but had less abdominal pain and a lower frequency of similar increases in plasma levels of amylase (4% versus 25%). Of 92 patients who consented to endoscopic manometry of the sphincter of Oddi, satisfactory manometric records were obtained in 84, 31 with and 53 without increases in AST after morphine or morphine-neostigmine. Those showing rises in AST had a higher frequency of abnormal manometric records (81% versus 57%, P = 0.025), higher basal pressures in the sphincter of Oddi (P = 0.0001) and higher pressures within ducts (P = 0.02). There was a significant correlation between sphincter basal pressures and intraduct pressures (r = 0.51, P less than 0.001). Rises in plasma AST after morphine are similar to those after morphine-neostigmine and are influenced by, or linked to, factors which determine sphincter basal pressures and intraduct pressures.

Responses to cholecystokinin octapeptide in patients with functional abdominal pain syndromes

“…*P < 0.05. there were significant increases in groups 2, 3 and 5 (controls) at either 5 or 10min. When compared with values during infusion of the placebo, individual increases in plasma catecholamines after CCK-8 ranged from approximately 10 to 1400% and were largely restricted to early time points (5,lOmin). However, the amplitude of these changes was neither consistent among patients within each group nor predictive of scores for pain and nausea in individual patients.…”

“…Significant increases in the ratio for noradrenaline were observed in groups 1,2 and 3 at 2 0 , s and lOmin respectively. For adrenaline and dopamine, Figure 2 Mean plasma concentrations of noradrenaline, adrenaline and dopamine before and after infusion of placebo in patients with pain and in control subjects (5). Patients with pain were divided into four groups; morphine responders with pain after cholecystectomy ( l ) , non-responders with pain after cholecystectomy (2), biliary pain (3) and irritable bowel syndrome (4).…”

MR Cholangiopancreatography: Improved Ductal Distention with Intravenous Morphine Administration

“…In addition to its primary analgesic effects, this drug induces contraction of the sphincter of Oddi (5)(6)(7)(8)(9)(10)(11). The resultant obstruction to fluid outflow at the ampulla of Vater produces increased intraluminal pressure and, thereby, increased distention of the biliary and pancreatic ducts.…”

Sympathetic activation: a mechanism for morphine induced pain and rises in liver enzymes after cholecystectomy?

“…Rises in aminotransferase are more prominent than rises in other liver enzymes and appear to be the earliest marker of biliary obstruction.2 Rises in plasma amylase are rare after morphine alone and appear to be less useful than aminotransferase as a marker of altered responsiveness to the combination of morphine and neostigmine.2 4 Results from the present study showed that morphine induced significant rises in plasma concentrations of noradrenaline and dopamine in patients showing rises in plasma concentrations of aminotransferase. For noradrenaline, significant rises were noted at 40 and 60 minutes after morphine, times which often preceded and closely followed the onset of pain.…”