Effects of massive overdose of epidural morphine sulphate

In summary, a patient was rapidly injected by error with morphine sulphate 60 mg epidurally. Left bundle branch block and ST segment depression signalled a problem. Respiratory depression occurred 15 minutes later. sympathetic blockade of the lower extremities was not detected. Injections of naloxone reversed the left bundle branch block, and respiratory depression but appeared to be cumulative and resulted in severe pain. A continuous naloxone infusion was effectively titrated to minimize respiratory depression for 19 hours without reversing analgesia. Twenty-four hours after epidural injection, the neurological examination was normal. Epidural morphine analgesia persisted for approximately 38.5 hours.