Side effects during continuous epidural infusion of morphine and fentanyl

White, Martin; Berghausen, Edward J.; Dumont, Stephen W.; Tsueda, Kentaro; Schroeder, Julia A.; Vogel, Robert L.; Heine, Michael F.; Huang, K. C.

doi:10.1007/bf03008321

Cited by 56 publications

(29 citation statements)

References 30 publications

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“…With morphine the incidence of pruritis ranges from 0% to 100% [2, 3, 5, 11, 13-15, 18, 21, 30, 31, 38] and is dose dependent [6,[29][30][31]. Previous studies have quoted incidences of pruritis for diamorphine 5.3-74% [10,39,49], fentanyl 5-75% [4, 5, 10, 13, 27, 35, 38-40, 42, 50], methadone 0-9% [14,17,33,34] and pethidine 13-59% [9,11,35,37,39].…”

Section: Discussionmentioning

confidence: 99%

Side‐effects of epidural infusions of opioid bupivacaine mixtures

Gedney

Liu

1998

Anaesthesia

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SummaryThe incidence of side-effects occurring with epidural diamorphine (0.05 mg.ml ¹1 ), fentanyl (2.0 mg.ml ¹1 ), methadone (0.1 mg.ml ¹1 ), morphine (0.05 mg.ml ¹1 ) and pethidine (1.0 mg.ml ¹1 ) used by infusion in combination with bupivacaine has been compared. One hundred and sixty patients were studied, 32 receiving each opioid. The incidence of nausea and vomiting was significantly greater with morphine than fentanyl (p ¼ 0.0097) and pethidine (p ¼ 0.0021). The incidence of pruritis was significantly greater with morphine and diamorphine than with methadone (p ¼ 0.012) and pethidine (p ¼ 0.027). Morphine was also associated with a significantly greater incidence of urinary retention than pethidine (p ¼ 0.012) and methadone (p ¼ 0.025).

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Section: Discussionmentioning

confidence: 99%

Side‐effects of epidural infusions of opioid bupivacaine mixtures

Gedney

Liu

1998

Anaesthesia

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“…Epidural analgesia is used in these patients because it is has better analgesic efficacy and is associated with a better rehabilitation profile, shortened hospital length of stay, reduced opioid use, and fewer side-effects [12][13][14]. However, PCEA with opioids is associated with a high incidence of PONV [15][16][17][18]. Effective prophylaxis of PONV is invariably linked to the quality and the extent of pain relief in patients at high risk for PONV because patients may become reluctant to initiate a bolus dose or increase the basal rate of PCEA to obtain adequate pain relief.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the prophylactic anti‐emetic efficacy of ramosetron and ondansetron in patients at high‐risk for postoperative nausea and vomiting after total knee replacement

Hahm

Choi

et al. 2010

Anaesthesia

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SummaryWe compared the prophylactic anti-emetic efficacy of ramosetron, a newly developed 5-HT 3 antagonist, and ondansetron in patients at high-risk for postoperative nausea and vomiting after total knee replacement. Eighty-four patients with three risk factors for postoperative nausea and vomiting (female, non-smoking and use of postoperative opioid use (ropivacaine and hydromorphone patient controlled epidural analgesia)) undergoing unilateral total knee replacement were randomly allocated to ramosetron 0.3 mg (n = 42) or ondansetron 4 mg (n = 42) groups. A complete response (no postoperative nausea and vomiting and no rescue anti-emetic) and the incidence of postoperative nausea and vomiting were assessed for 48 h after surgery at 0-2 h, 2-6 h, 6-24 h, and 24-48 h. More patients in the ramosetron group had a complete response between 2 and 48 h. The incidence of nausea between 2 and 24 h and the severity of nausea between 2 and 48 h were also less in the ramosetron group. Ramosetron was more effective than ondansetron in preventing postoperative nausea and vomiting in patients at high risk undergoing unilateral total knee replacement.

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“…The main application route of spinal epidural opioids remains the epidural catheter with single bolus doses or continuous infusion [15,17,19,20,51,52]. The level of drug concentration in the infusion is higher than the plasma level, thus allowing selective analgesia and avoiding major complications due to systemic drug actions [46,53].…”

Section: Discussionmentioning

confidence: 99%

“…Some of them are rare, but life-threatening, such as severe respiratory depression [52] or cervical spinal cord infarction [5]. Other complications, e.g., pruritus [24,34,48], urinary retention [1,8,17,30,51], and nausea [20,25,27,53], are more common, but not dangerous.…”

Section: Side Effects Of Epidural Opioidsmentioning

confidence: 99%

“…It was proposed that epidural morphine is a favourable method for relieving postoperative pain after bone surgery of the extremities and chest [2,7,9,13,28,33,36,37,50,51]. On the other hand, some authors stated that extradural opioids cannot be given safely unless the patient is monitored on an intensive care unit [10,22,29,32,41,43,46,52]. However, not very much is known about the benefits and risks of intra-operatively given single doses of epidural morphine in spinal surgery.…”

Section: Introductionmentioning

confidence: 96%

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Intra-operative epidural morphine, fentanyl, and droperidol for control of pain after spinal surgery A prospective, randomized, placebo-controlled, and double-blind trial

1996

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The present study was conducted to investigate the analgesic effects of intra-operatively administered epidural morphine in patients undergoing surgery for lumbar disc disease. Three treatment groups were constituted: one with 5.0 mg morphine and 2.5 mg dehydrobenzperidol (DHB) in 10 ml physiological saline, one with 5.0 mg morphine and 0.1 mg fentanyl in the same amount of saline, and one placebo group with saline only. The test solution was injected epidurally via catheter after haemostasis and before closure of the wound. Sixty eight patients were randomly assigned to each of the three groups and subjected to a double-blind evaluation. In the morphine/fentanyl and morphine/droperidol groups, significantly better analgesia was found as compared to the placebo group. No significant difference was found between the morphine/fentanyl and morphine/droperidol groups considering side effects of therapy, as well as duration and quality of analgesia. The side effects in the treatment groups were only slight and not significantly different from the placebo group. It was shown that additional epidural fentanyl offers no significant improvement of postoperative analgesia. No significant reduction of adverse effects could be found in the morphine/droperidol group compared to the morphine/fentanyl group. In conclusion, the intra-operative epidural application of morphine is a safe, effective and simple method for achieving sufficient analgesia in the first 24 hours after lumbar spinal surgery for disc disease.

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Side effects during continuous epidural infusion of morphine and fentanyl

Abstract: Respiratory effects, nausea, somnolence, and pruritus were compared during a 48-hr period of continuous epidural morphine (n = 34) and fentanyl (n = 32) 3, 6, 12, 24, 36, and 48

Cited by 56 publications

References 30 publications

Side‐effects of epidural infusions of opioid bupivacaine mixtures

Side‐effects of epidural infusions of opioid bupivacaine mixtures

Comparison of the prophylactic anti‐emetic efficacy of ramosetron and ondansetron in patients at high‐risk for postoperative nausea and vomiting after total knee replacement

Intra-operative epidural morphine, fentanyl, and droperidol for control of pain after spinal surgery A prospective, randomized, placebo-controlled, and double-blind trial

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