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Epidural morphine causes delayed and prolonged ventilatory depression.

R L Knill, J L Clement, W R Thompson

    Canadian Anaesthetists' Society Journal
    |November 1, 1981
    PubMed
    Summary
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    Epidural morphine causes delayed, prolonged respiratory depression, unlike subcutaneous injections. This effect on ventilation, primarily reducing tidal volume, is significant and long-lasting.

    Area of Science:

    • Anesthesiology
    • Pharmacology
    • Respiratory Physiology

    Background:

    • Epidural analgesia is commonly used for pain management.
    • Morphine is a potent opioid analgesic.
    • Understanding the respiratory effects of epidural morphine is crucial for patient safety.

    Purpose of the Study:

    • To compare the respiratory effects of epidural morphine versus subcutaneous morphine.
    • To assess the time course and magnitude of ventilatory changes after epidural morphine administration.

    Main Methods:

    • Volunteers received epidural or subcutaneous morphine (3.5 mg and 7.0 mg).
    • Ventilation, end-tidal carbon dioxide (PETCO2), and ventilatory response to added carbon dioxide were measured.
    • Measurements were taken before and at intervals up to six hours post-injection.

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    Main Results:

    • Subcutaneous morphine caused minimal changes in PETCO2 and ventilatory response.
    • Epidural morphine progressively reduced ventilation and increased PETCO2 over six hours.
    • Epidural morphine significantly blunted the ventilatory response to carbon dioxide, primarily by decreasing tidal volume.

    Conclusions:

    • Epidural morphine induces delayed and prolonged ventilatory depression.
    • The respiratory depression from epidural morphine is more pronounced and has a different pattern than subcutaneous administration.
    • These effects can persist for at least twenty-four hours, with a slow onset as analgesic effects wane.