An Experimental Study of Urodynamic Effects of Epidural Morphine and of Naloxone Reversal

Rawal, Narinder; Möllefors, Kaj; Axelsson, Kjell; Lingårdh, Gunnar; Widman, B.

doi:10.1213/00000539-198307000-00004

Cited by 184 publications

(72 citation statements)

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“…2 Morphine produces spinal inhibitory effects, which cause bladder relaxation and prevent bladder spasm. [12][13][14] In the present study, intrathecal morphine provided excellent postoperative analgesia, possibly because it prevented bladder spasm.…”

Section: Méthode : L'étude Prospective Et à Double Insu Comportait 42supporting

confidence: 52%

Mini-dose (0.05 mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate

Sakai

Use

Shimamoto

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To determine the optimal dose of intrathecal morphine that produces satisfactory analgesia with minimum side effects in elderly patients undergoing transurethral resection of the prostate (TURP). M Me et th ho od ds s: :In this double-blind prospective study, 42 patients undergoing TURP with spinal anesthesia were allocated to one of three groups. Group A (n = 14) received tetracaine, 10 mg, alone. Group B (n = 13) and Group C (n = 15) received morphine 0.05 mg and 0.10 mg, respectively, in combination with tetracaine. Postoperative pain, nausea and pruritus were evaluated using visual analogue scales (VAS). SpO 2 and respiratory rate were also assessed.R Re es su ul lt ts s: : At three, five, seven and 24 hr after spinal anesthesia, the VAS scores for pain in Groups B and C were significantly less than in Group A. Group C experienced significantly greater VAS scores for pruritus as compared to Groups A and B. There was no significant difference in the intensity of nausea among the three groups. No patient experienced hypoxemia (SpO 2 < 90%) and respiratory depression (respiratory rate < 10 beats·min -1 ) in any group. C Co on nc cl lu us si io on n: : A dose of 0.05 mg in intrathecal morphine with spinal anesthesia would be optimal for elderly patients undergoing TURP. Objectif : Déterminer la dose optimale de morphine intrathécale pour obtenir une analgésie satisfaisante et le moins d'effets secondaires possibles chez des patients âgés devant subir la résection transurétrale de la prostate (RTUP). Méthode : L'étude prospective et à double insu comportait Résultats : À trois, cinq et 24 h après la rachianesthésie, les scores de douleur à l'EVA ont été significativement plus bas dans les groupes B et C que dans le groupe A. Dans le groupe C, les patients ont eu des scores de prurit significativement plus élevés que ceux des groupes A et B. Il n'y a pas eu de différence intergroupe significative quant à l'intensité des vomissements. Aucun patient n'a souffert d'hypoxémie (SpO 2 < 90 %) ou de dépression respiratoire (fréquence respiratoire < 10 respirations·min -1 ). Conclusion : Une dose de 0,05 mg de morphine intrathécale combinée à la rachianesthésie serait optimale chez des patients âgés qui subissent une RTUP.FTER transurethral resection of the prostate (TURP), patients often suffer from pain caused by detrusor muscle spasm. 1,2 Intrathecal morphine provides an excellent long-lasting analgesia and the addition of morphine to spinal anesthesia has been used for postoperative analgesia after many surgical procedures. [3][4][5][6][7][8][9][10] Cunningham et al. demonstrated that intrathecal morphine was effective for analgesia after TURP. 11 On the other hand, intrathecal morphine is often accompanied by adverse effects such as pruritus, nausea and respiratory depression. Clinicians tend to use smaller doses to reduce the incidence of adverse effects. This study was carried out to examine the efficacy and adverse effects associated with low-dose intrathecal morphine in patients undergoi...

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Section: Méthode : L'étude Prospective Et à Double Insu Comportait 42supporting

confidence: 52%

Mini-dose (0.05 mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate

Sakai

Use

Shimamoto

et al. 2003

Can J Anesth/J Can Anesth

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“…Previous work has shown a higher incidence of side-effects with bolus administration [16,21]. Infusion rates were also adjusted to ensure patients received the minimum rate required to provide analgesia because for morphine the analgesic effect has been shown to plateau whereas the incidence of side-effects continues to increase with increasing dose [6,20,[29][30][31]. The use of a bolus of bupivacaine towards the end of surgery enabled us to avoid the use of loading boluses of opioid, even for those opioids with a slow onset of action.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of pruritis reported in previous studies varies considerably and is often only elicited on direct questioning. 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%

“…Cystometric studies in volunteers and dogs have shown relaxation of the detrussor with a corresponding increase in maximal bladder capacity with morphine [31,54] but diminished bladder compliance with slightly decreased maximal bladder capacity with methadone [54]. Previous studies have shown 40% of patients for lower limb orthopaedic surgery will require catheterisation after a nonopioid spinal anaesthetic and no epidural [55].…”

Section: Discussionmentioning

confidence: 99%

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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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“…3~ Urinary retention following intrathecal and epidural opioids is much more common than after intravenous or intramuscular administration of equivalent doses of opioid. [55][56][57] Urinary retention induced by intrathecal and epidural opioids is likely related to interaction with opioid receptors located in the sacral spinal cord. 55 This interaction promotes inhibition of sacral parasympathetic nervous system outflow which causes detntsor muscle relaxation and an increase in maximal bladder capacity leading to urinary retention.…”

Section: Urinary Retentionmentioning

confidence: 99%