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Catatonia after epidural morphine.

A Engquist, B C Jørgensen, H B Andersen

    Acta Anaesthesiologica Scandinavica
    |October 1, 1981
    PubMed
    Summary
    This summary is machine-generated.

    Continuous thoracic epidural morphine can cause severe neurological toxicity, including hallucinations and opisthotonos, in cancer patients. Early recognition and naloxone administration are crucial for managing this morphine intoxication syndrome.

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    Area of Science:

    • Neuroscience
    • Pharmacology
    • Oncology

    Background:

    • Continuous thoracic epidural analgesia is a common method for managing cancer pain.
    • Morphine is frequently used for epidural pain management.
    • Potential complications of epidural administration include local or systemic toxicity.

    Observation:

    • A 43-year-old male with bronchogenic carcinoma experienced neurological symptoms on day five of continuous thoracic epidural morphine infusion.
    • Symptoms included hallucinations, hyperthermia, spasticity, narcolepsy, and opisthotonos after a total dose of 24 mg morphine.
    • Vital signs such as respiratory rate and blood pressure remained stable.

    Findings:

    • The patient's neurological abnormalities were rapidly and completely reversed by intravenous naloxone.

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  • The syndrome was likely caused by rostral spread of morphine within the epidural space.
  • Catheter location and infusate volume were identified as potential contributing factors.

    • Implications:

    • Hallucinations and other neurological changes can be early indicators of impending morphine intoxication.
    • This case highlights the importance of monitoring for neurological side effects during continuous epidural morphine therapy.
    • Careful consideration of catheter placement and infusion volume is necessary to minimize the risk of rostral spread and toxicity.