Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Clinical differences in spinal opioid efficacy

Abstract

The case report describes a patient who presented with two simultaneously-occurring but distinct pain syndromes. Epidural morphine controlled the pain from the abdominoperineal resection, while thepainfrom a deep venous thrombosis was not masked. Such differential effects of epidural morphine onpain of varying origin supports physiological observations on the specificity of the site of action of spinal opioids.

Résumé

Voici l’histoire d’ une patiente souffrant simultanément de deux types de douleur distincts. Nous avons réussi à soulager la douleur causée par une résection abdomino-périnéale du rectum avec de la morphine par voie péridurale, sans toutefois occulter la douleur associée è une thrombophlébite profonde. L’effet sélectif de la morphine péridurale sur des douleurs d’ origines diverses peut trouver son explication dans l’ existence de plusieurs sites d’ action spécifiques au niveau rachidien.

References

  1. 1

    Bromage PR. The price of intraspinal narcotic analgesia. Basic constraints. Anesth Analg 1981; 60: 461–3.

  2. 2

    Bromage PR, Camporesi EM, Durant PAC, Nielsen CH. Nonrespiratory side effects of epidural morphine. Anesth Analg 1982; 61: 490–5.

  3. 3

    Bromage PR, Camporesi EM, Durant PAC, Nielsen CH. Influence of epinephrine as an adjuvant to epidural morphine. Anesthesiology 1983; 58: 257–62.

  4. 4

    Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology 1984; 61: 276–310.

  5. 5

    Gustaffson LL, Schildt B, Jacobsen K. Adverse effects of extradural and intrathecal opiates: Report of a nation-wide survey in Sweden. Br J Anaesth 1982; 54: 479–85.

  6. 6

    Magora F, Olshwang D, Eimerl D, Katzenelson R, Cotev S, Davidson JT. Observations on extradural morphine analgesia in various pain conditions. Br J Anaesth 1980; 52: 247–251.

  7. 7

    Hughes SC. Intraspinal opiates in obstetrics, Chapter 10. Anesthesia for Obstetrics, 2nd Edition. Shneider SM (edEd.). Levinson G. Williams and Wilkins, 1987.

  8. 8

    Kitahata LM, Kosaka Y, Taub A, Bonikos K, Hoffert, M. Lamina-specific suppression of dorsal-horn unit activity by morphine sulfate. Anesthesiology 1974; 41: 39–47.

  9. 9

    Cousins MJ, Bridenbaugh PO. Neural Blockade (2nd ed.). J.B. Lippincott Company 1988; pp. 955–1017.

  10. 10

    Covino BG, Scott DB. Handbook of Epidural Anaesthesia and Analgesia. Grune and Stratton, Inc 1985; pp. 77–80.

  11. 11

    Arner S, Arner B. Differential effects of epidural morphine in the treatment of cancer-related pain. Acta Anaesthesiol Scand 1985 29: 32–6.

  12. 12

    Yaksh TL, Gauman DM, Stevens CW. Receptors in the dorsal horn and intrathecal drug administration. Ann NY Acad Sci 1988; 531: 90–107.

Download references

Author information

Correspondence to Slawomir Organowski.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Organowski, S., Duncan, P.G. Clinical differences in spinal opioid efficacy. Can J Anaesth 36, 448 (1989). https://doi.org/10.1007/BF03005345

Download citation

Key words

  • anaesthetic techniques: epidural, opiates
  • complications: thrombosis
  • pain: postoperative
  • pharmacology: narcotics, spinal
  • veins: thrombophlebitis