Serum Levels Following Epidural Administration of Morphine and Correlation with Relief of Postsurgical Pain

Weddel, S. J.; Ritter, Richard R.

doi:10.1097/00000542-198103000-00007

Cited by 77 publications

(7 citation statements)

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“…Some previous studies reported that epidural injection of morphine resulted in a similar level of plasma morphine concentration when compared to IM injection of morphine [20,21]. In a study by Weddel and Ritter on morphine (5 mg/70 kg) that was injected epidurally [22], the mean time to onset of significant effects was 15 minutes; an adequate level of analgesia was found to last 37.9 hours. Based on what they found about the analgesic efficacy of morphine and its plasma concentration levels, researchers have supported the concept of the selective action of morphine on the spinal cord.…”

Section: Discussionmentioning

confidence: 96%

Plasma Concentrations of Morphine during Postoperative Pain Control

Park

Kim

et al. 2011

Korean J Pain

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BackgroundMorphine has been commonly used for postoperative pain control. We measured plasma concentrations of morphine and compared the efficacy and safety of continuous epidural analgesia (CEA) using morphine-bupivacaine with intravenous patient controlled analgesia (IV-PCA) with morphine for 48 hrs after the end of the operation.MethodsNineteen patients undergoing Mile's operation were assigned to receive a morphine loading dose of 5 mg followed by IV-PCA with 0.1% morphine (IV-PCA group, n = 9) or a morphine loading dose of 2 mg and 0.125% bupivacaine 10 ml, followed by CEA with 0.004% morphine and 0.075% bupivacaine at a rate of 5 ml/hr (CEA group, n = 10). The plasma concentrations of morphine were measured and visual analog scales (VAS) for pain were recorded at 1, 6, 12, 24, and 48 hr postoperatively and the effects on respiration and any other side effects were noted.ResultsThe mean maximal and minimal levels of plasma morphine were 40.2 ± 21.2 ng/ml and 23.4 ± 9.7 ng/ml for the IV-PCA group and 11.8 ± 3.5 ng/ml and 8.2 ± 1.9 ng/ml for the CEA group, respectively. Resting and dynamic pain scores were significantly lower in the CEA group than in the IV-PCA group. There were no significant differences for the effects on respiration and for any side effects between the two groups.ConclusionsWe evaluated plasma concentrations of morphine with CEA using morphine-bupivacaine and IV-PCA using morphine for the postoperative pain control. The CEA group had better postoperative analgesia than that of the IV-PCA group and the incidence of side effects were not significantly different between the two groups.

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Section: Discussionmentioning

confidence: 96%

Plasma Concentrations of Morphine during Postoperative Pain Control

Park

Kim

et al. 2011

Korean J Pain

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“…This dosage exceeds previously reported dosages for epidural and intrathecal administration in dogs (0.05–0.2 mg/kg). When morphine is applied directly to the epidural space during surgery, a considerable amount of the drug is either absorbed systemically through the venous network of the surrounding soft tissue and spinal canal or is externally eliminated by irrigation and suction. Although it is impossible to quantify the amount of morphine that diffuses into the CSF and subsequently to the dorsal root ganglion and spinal cord, we assume that only a small amount of the dosage is delivered to its target site.…”

Section: Discussionmentioning

confidence: 99%

“…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 .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…Several studies have shown that the time to reach maximum concentration in plasma, 19–34 ng/mL, is 10–15 min for doses within the normal therapeutic range (2–10 mg) in humans. The peak morphine levels reported in CSF (375 ng/mL) were 100–200 times higher than the corresponding plasma morphine levels (Bromage et al ., 1980; Chayen et al ., 1980; Mogora et al ., 1980; Rawal et al ., 1981; Weddel & Ritter, 1981; Nordberg et al ., 1983; Dahlstrom et al ., 1986). In these reports, CSF morphine concentrations were considerably higher than the plasma concentrations at all times (Nordberg et al ., 1983; Tamsen et al ., 1983).…”

Section: Discussionmentioning

confidence: 99%

Postoperative analgesia in dogs receiving epidural morphine plus medetomidine

Pacharinsak

Greene

Keegan

et al. 2003

Vet Pharm & Therapeutics

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This investigation was carried out to compare the postoperative analgesia and plasma morphine concentrations in dogs given epidural morphine or epidural morphine combined with medetomidine prior to surgery. Twelve dogs (seven males and five females) with ruptured cranial cruciate ligaments presented to the Washington State University Veterinary Teaching Hospital. Six dogs received an epidural injection of morphine (0.1 mg/kg) and six dogs received epidural morphine (0.1 mg/kg) combined with medetomidine (0.005 mg/kg). Numeric rating scale (NRS) pain scores and cumulative pain scores (CPS) were assigned to 10-min segments of video. Video segments, heart rates and respiratory rates were recorded prior to premedication and at 4, 8, 12, 18 and 24 h after epidural injection. Blood was sampled from the cephalic vein at each of these times and during anesthesia at 0.5, 1, 2 and 3 h after epidural injection. Data were analyzed using either Friedman's test or one-way anova for repeated measures. In the morphine group, significant increases compared with premedication values were detected at 4, 8 and 12 h after epidural injection for NRS and at 4 and 12 h after epidural injection for CPS. In the morphine plus medetomidine group, NRS was significantly higher at 4 and 8 h whereas there were no differences from baseline values for CPS. Plasma morphine concentrations were not significantly different between treatment groups, but were significantly increased compared with preinjection values at 0.5, 1, 12, 18, and 24 h in the morphine plus medetomidine group. Epidurally administered morphine combined with medetomidine was associated with only minor benefits based on subjective pain scoring when compared with morphine alone in these dogs undergoing repair of a ruptured cranial cruciate ligament.

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Serum Levels Following Epidural Administration of Morphine and Correlation with Relief of Postsurgical Pain

Cited by 77 publications

References 0 publications

Plasma Concentrations of Morphine during Postoperative Pain Control

Plasma Concentrations of Morphine during Postoperative Pain Control

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

Postoperative analgesia in dogs receiving epidural morphine plus medetomidine

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