The Effects of Continuous Intravenous Naloxone on Epidural Morphine Analgesia

Abstract

Forty-Jive patients undergoing Caesarean section under epidural anaesthesia with bupivacaine were randomly allocated to three groups. Group I received 4 mg of epidural morphine immediately postoperatively and 2 mg naloxone by intravenous infusion for 12 hourspostoperatively; group 2 was treated as group I but without naloxone infusion: group 3 received I0 mg morphine intramuscularly and 20 ml epidural saline after delivery of the baby. Epidural morphine 4 mg produced better postoperative analgesia than 10 mg of morphine intramuscularly (p < 0.001) and the intravenous infusion ofnaloxone didnot ablate the analgesic eflects of epidural morphine. The incidence of itching and vomiting was higher in the epidural opioid groups @<0.05) and intravenous naloxone, although it reduced the severity of the itching, did not reduce its overall incidence. Respiratory depression was not detected in any of the three groups.

Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials

“…Of the 22 analysed trials, one was on treatment of established pruritus [33], and one on both, prevention and treatment (in two separate randomized designs) [34]. The others were on prevention only [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] ( Table 1). Data on 1477 patients were analysed.…”

“…In trials on prevention, analgesia was with epidural morphine in 10 trials [35,39,[42][43][44]46,47,50,51,54], with intrathecal morphine in five [34,36,41,49,52], with intrathecal sufentanil in two [37,53], with a combination of intrathecal morphine and fentanyl in one trial [38], with i.v. morphine in one [40], with i.v.…”

“…All failures were successfully treated with intravenous naloxone 40-80 mg. Three women receiving propofol felt dizzy compared with one who received Intralipid [33]. [38,51] to variable doses (i.e. mg kg À1 h À1 ) using patients' average body weight as reported in the original trials.…”

Reversible Paralysis and Loss of Deep Pain Sensation After Topical Intrathecal Morphine Administration Following Durotomy

“…Various authors have studied the influence of naloxone infusion on postoperative adverse effects and analgesia after epidural and intrathecal morphine administration . One study established that 1 µg/kg/min naloxone infusion was associated with inferior analgesia in people undergoing lumbar laminectomy treated with intrathecal morphine .…”

“…Various authors have studied the influence of naloxone infusion on postoperative adverse effects and analgesia after epidural and intrathecal morphine administration. [45][46][47][48] One study established that 1 mg/kg/min naloxone infusion was associated with inferior analgesia in people undergoing lumbar laminectomy treated with intrathecal morphine. 46 Nevertheless, a lower dose of naloxone infusion reversed several adverse effects associated with epidural and intrathecal morphine administration while sparing or even enhancing 45 its analgesic effect.…”