Aspiration Pneumonitis Caused by Delayed Respiratory Depression Following Intrathecal Morphine Administration

Whang, Bo Young; Jeong, Seong Whan; Leem, Jeong Gill; Kim, Young Ki

doi:10.3344/kjp.2012.25.2.126

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…Pulmonary haemorrhage induced by opioids may be a result of neurogenic pulmonary oedema or negative pressure pulmonary oedema. Other mechanism of opioid‐induced lung injury include aspiration from central nervous depression 44 ,. immunosuppression and eosinophilic pneumonia induced by hypersensitivity 45 …”

Section: Opioids Pulmonary Oedema and Endothelial Functionmentioning

confidence: 99%

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Opioid effect on lungs

Yamanaka

Sadikot

2013

Respirology

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Opioids are widely used for their analgesic properties for the management of acute and chronic pain related to a variety of illnesses. Opioid usage is associated with adverse effects on respiration which are often attributed to depression of the central nervous system. Recent data indicate that opioid use has increased over the last two decades. There is also increasing evidence that opioids have a variety of effects on the lungs besides suppression of respiration. Opioids can affect immune cells function, increase histamine release causing bronchospasm, vaso-constriction and hypersensitivity reactions. Together, these actions have a variety of effects on lung function. Here, we provide a comprehensive review of the effects of opioids on the lungs including the respiratory centre, immune function, airways and pulmonary vasculature.

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Section: Opioids Pulmonary Oedema and Endothelial Functionmentioning

confidence: 99%

“…Other mechanism of opioid-induced lung injury include aspiration from central nervous depression. 44 , immunosuppression and eosinophilic pneumonia induced by hypersensitivity. 45…”

Section: Opioids Pulmonary Oedema and Endothelial Functionmentioning

confidence: 99%

Opioid effect on lungs

Yamanaka

Sadikot

2013

Respirology

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“…12 Patients sometimes experience nausea, vomiting, and loss of consciousness and respiratory disorders after receiving morphine. 13 The availability of an appropriate alternative medicine is one of the needs of these patients, able to demonstrate the analgesic effect of morphine, without effects and complications. Buprenorphine is a partial opioid agonist of the μ-receptor, which exhibit no adverse effects due to antagonistic properties; it is currently used in the treatment of opiate dependence, and it has a special place in the treatment of these patients.…”

mentioning

confidence: 99%

Comparison of sublingual buprenorphine and intravenous morphine in reducing bone metastases associated pain in cancer patients

Sotodeh

Mohaghegh

2019

Eur J Transl Myol

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Bone metastases is one of the most common causes of pain in cancer patients and have a significant effect on their quality of life. The most common symptom of bone metastases is pain that gradually develops. Morphine is used to relieve pain in these patients, poorly accepted by patients due to its adverse events. Therefore, the current study was aimed to compare the effect of sublingual buprenorphine, with certainly lower complications with morphine. Fourth patients were divided into 2 groups. In group A, metastatic cancer patients received 2.5 mg of intravenous (IV) morphine. Furthermore, in group B, sublingual tablet of buprenorphine (one-fourth of a 500 μg tablet) was administered sublingually. Pain was measured 15, 30, and 45 minutes after the onset of pain using visual analog scale (VAS) Ruler. Based on the obtained data, two groups A and B were compared using SPSS 23 software. There was a significant difference between the patient's pain intensity after 15 and 30 minutes from the onset of pain in both groups. Due to the fact that the duration of the effect of morphine is 3-4 hours and the duration of the effect of sublingual buprenorphine is 6-8 hours, therefore, morphine showed fast acting forms of opioids (P= 0.001). The required dose level on the first day was similar in both groups and there was no statistically significant difference between the two groups. While on the second and third days, the median dose in group A (morphine) was greater than group B (buprenorphine), indicating prolonged duration of action for buprenorphine compared with morphine, thus requiring a lower subsequent doses. The results of this study suggested that sublingual buprenorphine is a higher effective drug compared to intravenous morphine during after operation. With regard to easy and painless administration, it seems that its use can be useful in controlling pain due to bone metastases in cancer patients.

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“…These include less time to patient mobilization and dietary intake, lower rate of general complications, and reduced mortality [14, 15, 17]. On the other hand, epidural analgesia was associated with hypotension, increased use of vasopressors, and impaired kidney function, and intrathecal analgesia was associated with pruritus and late respiratory depression [12, 14, 16, 18–21]. The present study was neither powered nor designed to detect such effects; however, no effects on patient recovery after liver resection and no procedure‐specific complications were observed.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Intrathecal and Intravenous Morphine for Analgesia After Hepatectomy: A Randomized Controlled Trial

et al. 2020

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Background Effective analgesia is essential for patient recovery after liver resection. This study aimed to evaluate the effects of the addition of preoperative intrathecal morphine to multimodal intravenous analgesia in patients undergoing liver resection. Methods In this single-blind randomized controlled trial, patients undergoing liver resection were randomly assigned to the patient-controlled analgesia with (ITM-IV) or without (IV) preoperative intrathecal morphine groups. All patients received acetaminophen and dexketoprofen. The primary outcome was pain severity at rest over three postoperative days, assessed using the numerical rating scale (NRS). Results The study included 36 patients (18 in each group). The mean maximum daily NRS scores over the first three postoperative days in the ITM-IV and IV groups were 1.3, 1.1, and 0.3 and 1.6, 1.1, and 0.7, respectively (p = 0.580). No differences were observed in pain severity while coughing, with corresponding scores of 2.8, 2.1, and 1.1, respectively, in the ITM-IV group and 2.3, 2.2, and 1.5, respectively, in the IV group (p = 0.963). Proportions of patients reporting clinically significant pain at rest and while coughing were 11.1% and 44.4%, respectively, in the ITM-IV group, and 16.7% and 44.4%, respectively, in the IV group (both p [ 0.999). Cumulative morphine doses in the ITM-IV and IV groups were 26 mg and 17 mg, respectively (p = 0.257). Both groups also showed similar time to mobilization (p = 0.791) and solid food intake (p = 0.743), sedation grade (p = 0.584), and morbidity (p = 0.402). Conclusions Preoperative intrathecal morphine administration provides no benefits to multimodal analgesia in patients undergoing liver resection. Trial registration number Clinicaltrial.gov Identifier: NCT03620916

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Aspiration Pneumonitis Caused by Delayed Respiratory Depression Following Intrathecal Morphine Administration

Cited by 6 publications

References 11 publications

Opioid effect on lungs

Opioid effect on lungs

Comparison of sublingual buprenorphine and intravenous morphine in reducing bone metastases associated pain in cancer patients

A Comparison of Intrathecal and Intravenous Morphine for Analgesia After Hepatectomy: A Randomized Controlled Trial

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