Extended-release epidural morphine and postoperative nausea or vomiting

Macias, Monica N.; Hall, Thomas G.; Ostlund, Jodi

doi:10.2146/ajhp070410

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…This approach is supported by previous studies. [142030] Additionally, diphenhydramine, ondansetron, and phenergan were administered on an as-needed basis. To avoid urinary retention, Foley catheters were placed intraoperatively and maintained for at least 36 hours.…”

Section: Resultsmentioning

confidence: 99%

Randomized trial demonstrates that extended-release epidural morphine may provide safe pain control for lumbar surgery patients

Offley¹,

Coyne²,

Horodyski³

et al. 2013

Surg Neurol Int

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Background:Safe and effective postoperative pain control remains an issue in complex spine surgery. Spinal narcotics have been used for decades but have not become commonplace because of safety or re-dosing concerns. An extended release epidural morphine (EREM) preparation has been used successfully in obstetric, abdominal, thoracic, and extremity surgery done with epidural anesthesia. This has not been studied in open spinal surgery.Methods:Ninety-eight patients having complex posterior lumbar surgery were enrolled in a partially randomized clinical trial (PRCT) of low to moderate doses of EREM. Surgery included levels from L3 to S1 with procedures involving combinations of decompression, instrumented arthrodesis, and interbody grafting. The patients were randomized to receive either 10 or 15 mg of EREM through an epidural catheter placed under direct vision at the conclusion of surgery. Multiple safety measures were employed to prevent or detect respiratory depression. Postoperative pain scores, narcotic utilization, and adverse events were recorded.Results:There were no significant differences between the two groups as to supplemental narcotic requirements, pain scores, or adverse events. There were no cases of respiratory depression. The epidural narcotic effect persisted from 3 to 36 hours after the injection.Conclusion:By utilizing appropriate safety measures, EREM can be used safely for postoperative pain control in lumbar surgery patients. As there was no apparent advantage to the use of 15 mg, the lower 10 mg dose should be used.

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Section: Resultsmentioning

confidence: 99%

Randomized trial demonstrates that extended-release epidural morphine may provide safe pain control for lumbar surgery patients

Offley¹,

Coyne²,

Horodyski³

et al. 2013

Surg Neurol Int

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“…Morphine is an opioid drug used for analgesic treatment. Morphine hydrochloride is a strong analgesic (7). Analgesia with morphine hydrochloride via the epidural space is a conventional treatment after the cesarean section.…”

Section: Discussionmentioning

confidence: 99%

Rashes following cesarean delivery: a case report

et al. 2020

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This work reports a case of rashes on multiple parts of the body following cesarean delivery caused by routine use of cefuroxime sodium and morphine during the perioperative period. A 29-yearold woman underwent a lower segment cesarean section under combined spinal-epidural anesthesia.During surgery, cefuroxime sodium was administered intravenously following the division of the umbilical cord for the prevention of infection. Morphine hydrochloride was given for analgesia at the end of the procedure. Rashes and pruritus appeared on the patient's abdomen, back and thighs. Cephalosporins and opioids may cause rashes and pruritus. According to the patient's physical signs and the time of drug injection, we considered the rash and pruritus adverse reactions caused by cefuroxime sodium and morphine hydrochloride. After the discontinuation of the medications, antiallergic treatment and the other treatment of symptoms, the patient's symptoms gradually subsided. To this end, we speculate that cefuroxime sodium or morphine hydrochloride cause adverse reactions, including rashes in patients. Physicians, nurses, and clinical pharmacists should closely observe patients who receive these medications. The medications should be at once stopped if an adverse reaction occurs.

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“…Epidural morphine provides prolonged and effective postoperative analgesia, and it is commonly used for analgesia after cesarean section (CS). [1] While spinal morphine is a common method for post-cesarean analgesia in European and Americas, epidural morphine remains a routine technique in mainland China. Among the side effects of neuraxial morphine, pruritus is one of the most troublesome.…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors for epidural morphine induced pruritus in parturients receiving cesarean section

et al. 2019

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This study is designed to clarify the incidence of epidural morphine induced pruritus (EMIP) in Chinese Han and Tibetan parturients after cesarean section (CS) and to identify the correlated risk factors.This is a prospective multicenter observational study. Follow-up evaluations were performed at 3 hours, 6 hours, 12 hours, 24 hours, and 48 hours after morphine administration. The primary outcome was EMIP incidence. Other details were also recorded for risk factor screening.Totally 284 parturients receiving CS were enrolled and 247 completed the study. The overall incidence of EMIP was 18.6% (46 in 247). The onset of pruritus was 5.6 ± 4.8 hours (mean ± SD) after morphine administration and the duration of pruritus was 14.0 ± 8.8 hours. Logistic regression models was built with 5 variables, history of allergy, serotonin receptor antagonist administration, I.V. fentanyl administration, epidural morphine volume and VAS pain score. Results of showed that 2 of the variables, history of allergy (P < .001) and serotonin receptor antagonist (P < .05), were significantly correlated with incidence of EMIP.In conclusion, EMIP incidence in our study was 18.6%. Positive medical history of allergy and not using serotonin receptor antagonist were potential risk factors of EMIP development.Trial registration: ChiCTR-OPC-17012345

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Extended-release epidural morphine and postoperative nausea or vomiting

Cited by 5 publications

References 4 publications

Randomized trial demonstrates that extended-release epidural morphine may provide safe pain control for lumbar surgery patients

Randomized trial demonstrates that extended-release epidural morphine may provide safe pain control for lumbar surgery patients

Rashes following cesarean delivery: a case report

Incidence and risk factors for epidural morphine induced pruritus in parturients receiving cesarean section

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