Respiratory depression after intrathecal narcotics

Abstract

Summary

Efficacy and safety of intrathecal morphine for post cesarean section analgesia

“…Despite the early reports regarding the analgesic efficacy of intrathecal morphine, 7,8,9 it failed to gain widespread use due to high incidence of respiratory depression, related to the use of large dose of morphine. Wang et al 6 with 0.5 and 1.0 mg of intrathecal morphine had 15-22 hour of analgesia without respiratory depression whereas others 10,11,12 reported high frequency of delayed respiratory depression with dose of 2-15 mg. Subsequently, mini-dose concept of intrathecal morphine had promising results.…”

Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration

“…[70][71][72][73][74][75][76][77][78][79] RCTs comparing naloxone 80,81 or naltrexone [82][83][84] with placebo are equivocal regarding preprocedure prophylaxis for respiratory depression, hypoxemia, sedation, or somnolence (Category A2-E evidence). [70][71][72][73][74][75][76][77][78][79] RCTs comparing naloxone 80,81 or naltrexone [82][83][84] with placebo are equivocal regarding preprocedure prophylaxis for respiratory depression, hypoxemia, sedation, or somnolence (Category A2-E evidence).…”

Epidural analgesia in gastrointestinal surgery

“…Lipophilic opioids, such as fentanyl which is 800–1600 times more lipid soluble than morphine, penetrate the spinal cord quickly when introduced into the epidural space. Morphine is preferentially distributed in the cerebrospinal fluid and may ascend within the cerebrospinal fluid by diffusion and concentration gradients—aided by coughing and mobilization133 — to affect higher centres134, 135. The most frequent side‐effects of cephalad migration of epidural opioid are dizziness (6 per cent), pruritus (4·4 per cent), nausea (3·2 per cent), and respiratory depression (0·04 per cent) that may be late in onset135, 136.…”

“…Morphine is preferentially distributed in the cerebrospinal fluid and may ascend within the cerebrospinal fluid by diffusion and concentration gradients—aided by coughing and mobilization133 — to affect higher centres134, 135. The most frequent side‐effects of cephalad migration of epidural opioid are dizziness (6 per cent), pruritus (4·4 per cent), nausea (3·2 per cent), and respiratory depression (0·04 per cent) that may be late in onset135, 136. In addition, both blockade of the sacral parasympathetic outflow and a direct effect on bladder autonomic receptors produce urinary retention in up to 80 per cent of patients137.…”