Ventilatory Effects of Epidural Diamorphine — A Comparison with Epidural Lignocaine

  • G. M. Cooper
  • N. W. Goodman
  • C. Prys-Roberts
  • L. Jacobson
  • G. A. Douglas
  • J. Dye
Part of the European Academy of Anaesthesiology book series (ANAESTHESIOLOGY, volume 2)


The administration of opioids by the epidural route pioneered by Behar et al.(1) has achieved great popularity as a means of providing postoperative analgesia. Although morphine has been the commonest opioid to be used by either intrathecal or epidural administration(2–7), other opioids such as pethidine, methadone, buprenorphine, fentanyl and diamorphine have also been used in a search for prolonged analgesia free of undesirable side effects. Although most authors have described the advantages and benefits of epidural or intrathecal opioids, there has been much concern about the wisdom of using such methods of postoperative pain relief on general hospital wards in view of case reports of profound ventilatory depression occurring either shortly after, or many hours after, drug administration(8–11).


Mean Arterial Pressure Minute Ventilation Ventilatory Response Epidural Morphine Analogue Pain Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Behar M, Magora F, Olshwang D, Davidson JT (1979) Epidural morphine in the treatment of pain. Lancet 1; 527.PubMedCrossRefGoogle Scholar
  2. 2.
    Wang JK, Nauss LA, Thomas JE (1979) Pain relief by intrathecally applied morphine. Anesthesiology 50; 149.PubMedCrossRefGoogle Scholar
  3. 3.
    Matthews ET and Abrams LD (1980) Intrathecal morphine in open heart surgery. Lancet 11; 543.CrossRefGoogle Scholar
  4. 4.
    McClure JH, Chambers WA, Moore E, Scott DB (1980) Epidural morphine for postoperative pain. Lancet 1; 975.PubMedCrossRefGoogle Scholar
  5. 5.
    Chambers WA, Sinclair CJ, Scott DB (1981) Extradural morphine for pain after surgery. Brit J Anaesth 53; 921.PubMedCrossRefGoogle Scholar
  6. 6.
    Gjessing J and Tomlin PJ (1981) Post-operative pain control with intrathecal morphine. Anaesthesia 36; 268.PubMedCrossRefGoogle Scholar
  7. 7.
    Torda TA and Pybus DA (1981) Clinical experience with epidural morphine. Anaesth Int Care 9; 129.Google Scholar
  8. 8.
    Glynn CJ, Mather LE, Cousins MJ, Wilson PR and Graham JR (1979) Spinal narcotics and respiratory depression. Lancet 11; 356.CrossRefGoogle Scholar
  9. 9.
    Scott DB and McClure J (1979) Selective epidural analgesia. Lancet 1; 1410.PubMedCrossRefGoogle Scholar
  10. 10.
    Christensen V (1980) Respiratory depression after extradural morphine. Brit J Anaesth 52; 841.PubMedCrossRefGoogle Scholar
  11. 11.
    Davies GK, Tolhurst-Cleaver CL and James TL (1980) CNS depression from intrathecal morphine. Anesthesiology 52; 280.PubMedCrossRefGoogle Scholar
  12. 12.
    Editorial (1980) Epidural opiates. Lancet 1; 962.Google Scholar
  13. 13.
    Bromage PR (1981) Editorial: The price of intraspinal narcotic analgesia: basic constraints. Anesth Analg 60; 461.PubMedGoogle Scholar
  14. 14.
    Simpson BR, Parkhouse J, Marshall R and Lambrechts W (1961) Extradural analgesia and the prevention of postoperative respiratory complications. Brit J Anaesth 33; 628.PubMedCrossRefGoogle Scholar
  15. 15.
    Bond MR and Pilowsky I (1966) Subjective assessment of pain and its relationship to the administration of analgesics in patients with advanced cancer. J Psychosomat Res 10; 203.CrossRefGoogle Scholar
  16. 16.
    Read DJC (1967) A clinical method for assessing the ventilatory response to carbon dioxide. Australian Ann Med 16; 20.Google Scholar
  17. 17.
    Nunn JF (1977) Applied Respiratory Physiology, 2nd edition, p 45. London, Butterworths.Google Scholar
  18. 18.
    Torda TA, Pybus DA, Liberman H, Clark M, Crawford M (1980) Experimental comparison of extradural and I M morphine. Br J Anaesth 52; 939.PubMedCrossRefGoogle Scholar
  19. 19.
    Rutter DV, Skewes DG and Morgan M (1981) Extradural opioids for postoperative analgesia. A double-blind comparison of pethidine, fentanyl and morphine. Br J Anaesth 53; 915.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1982

Authors and Affiliations

  • G. M. Cooper
  • N. W. Goodman
  • C. Prys-Roberts
  • L. Jacobson
  • G. A. Douglas
  • J. Dye

There are no affiliations available

Personalised recommendations