Paranoid Psychosis After Intrathecal Morphine

Christie, Joan M.; Meade, William; Markowsky, Susan J.

doi:10.1213/00000539-199312000-00037

Cited by 9 publications

(5 citation statements)

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“…We believe that such a clinical setting is not transferable to adverse effects of a single shot of intrathecal morphine in a perioperative setting, unless a serious medication error occurs. Still, massive doses of intrathecal morphine may result in neurotoxicity, psychosis, myoclonias, epilepsy, allodynia, and motor block [50][51][52][53][54][55][56][57].…”

Section: Discussionmentioning

confidence: 99%

Serious Adverse Events after a Single Shot of Intrathecal Morphine: A Case Series and Systematic Review

Koning

Reussien

Vermeulen

et al. 2022

Pain Research and Management

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Background. The dose of intrathecal morphine is important because of its narrow therapeutic range. Due to a compounding error, pharmacy-compounded, ready-to-use syringes contained 1 mg ml−1 morphine instead of the intended 50 mcg ml−1. Six patients consequently received this twenty-fold dose. This study aims to describe the serious adverse events in these six patients and a systematic review is added to describe the characteristics of serious adverse events after intrathecal morphine. Methods. A retrospective case series described all six patients that received the erroneous morphine intrathecally for analgesia after laparoscopic segmental colonic resections. The patients’ charts were reviewed for the occurrence, timing, duration and management of adverse events, the vital signs at the night after surgery, and length of hospital stay. A systematic review investigated characteristics of serious adverse events after intrathecal morphine in a perioperative setting. Results. Four patients had a serious adverse event, which was respiratory depression combined with somnolence (n = 3) and hypotension (n = 1). The review yielded 63 cases with serious adverse events, predominantly somnolence and/or respiratory depression. The onset occurred between 2 and 24 hours after injection. The severity of symptoms varied and life-threatening respiratory depression only occurred after a dose >900 mcg or when potentiating medication was used. Naloxone did not affect analgesia. No prolonged sequalae occurred. Conclusion. This study reveals that respiratory depression and somnolence are the predominant serious adverse events after intrathecal morphine in a perioperative setting and demonstrated a large variation in the presentation of symptoms.

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Section: Discussionmentioning

confidence: 99%

Serious Adverse Events after a Single Shot of Intrathecal Morphine: A Case Series and Systematic Review

Koning

Reussien

Vermeulen

et al. 2022

Pain Research and Management

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“…They stated that most of these side effects spontaneously resolved with the exception of sweating and peripheral edema, which persisted. Other less common side effects that have been reported in the literature include paranoia, 118 Whereas most side effects of intrathecal morphine are not always dose related, bupivacaineinduced side effects are dose related. These side effects are related to the anesthetic effects of the bupivacaine at the spinal level and include paresthesias, motor and sensory block, arterial hypotension, and urinary retention.…”

Section: Table Available In Print Onlymentioning

confidence: 99%

Long-term spinal analgesic delivery: A review of the preclinical and clinical literature

Wallace

Yaksh

2000

Regional Anesthesia and Pain Medicine

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“…There are several case reports of psychosis related to pain medications; however, these are mostly associated with NSAIDs use in patients with or without previous psychiatric diagnoses or psychosis [11][12][13][14][15][16][17][18][19][20]. There was another case of a 25 year old female with history of SLE developed an acute psychotic reaction secondary to administration of nalbuphen IV for opioid induced pruritus [21].…”

Section: Discussionmentioning

confidence: 99%

Oral Hydrocodone Induced Acute Psychosis in an Adult Male: A CaseReport.

Rasheed¹,

Baronia²,

Sharma³

et al. 2015

J Clin Case Rep

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Hydrocodone is an opioid derived from codeine, which has been used for many years as a short-acting analgesic combined with acetaminophen (or less commonly ibuprofen). Common and severe psychiatric side effects included include mental depression, mood changes, hallucination, delirium, somnolence, agitation, and dysphoria. This is a report of a particular case that resulted in acute psychosis after immediately starting on Hydrocodone because of back pain in a 35 year old male, with no past psychiatrist history. The patient returned to his baseline mental status after the hydrocodone was discontinued. Earlier research was published about these symptoms are the ones where hydrocodone was used in combination with other drugs, but in this unique case the patient was not any other medication except the hydrocodone. This unique case showed an association between the short term use of hydrocodone and development of psychiatric symptoms. Recognition of these uncommon psychiatric side effects of hydrocodone usage will allow for early recognition of their etiology, symptoms and treatment. Psychotic symptoms induce by analgesics are not a common condition but they still remain under diagnosed and untreated.

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Paranoid Psychosis After Intrathecal Morphine

Cited by 9 publications

References 0 publications

Serious Adverse Events after a Single Shot of Intrathecal Morphine: A Case Series and Systematic Review

Serious Adverse Events after a Single Shot of Intrathecal Morphine: A Case Series and Systematic Review

Long-term spinal analgesic delivery: A review of the preclinical and clinical literature

Oral Hydrocodone Induced Acute Psychosis in an Adult Male: A CaseReport.

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