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Pethidine reverses morphine-induced delirium

P D McLoughlin1

  • 1Department of Anaesthesia, Royal Perth Hospital, Western Australia.

Insights

Postoperative delirium in a young patient was linked to morphine-induced biliary colic. A small dose of pethidine rapidly resolved the delirium, suggesting biliary spasm as a potential cause.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Gastroenterology

Background:

  • Postoperative delirium is a common complication.
  • Morphine is frequently used for pain management post-surgery.
  • Biliary colic can cause significant abdominal pain and distress.

Observation:

  • A young patient experienced prolonged postoperative delirium.
  • The delirium was suspected to be associated with morphine-induced biliary colic.
  • Naloxone administration did not alleviate the symptoms.

Findings:

  • A small dose of pethidine resulted in a rapid and complete return to lucidity.
  • This suggests that the delirium was primarily caused by biliary spasm rather than opioid-induced central nervous system depression.
  • Morphine can precipitate or exacerbate biliary spasm.

Implications:

  • Unrecognized biliary spasm should be considered in postoperative patients presenting with agitation or delirium after morphine administration.
  • This case highlights the importance of considering atypical side effects of common analgesics.
  • Further investigation into the mechanism of morphine-induced biliary spasm may be warranted.

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