Itching as a side‐effect of epidural morphine
Duffy, Brian L.
1981-01-01 00:00:00
Correspondence 67 Nuclear magnetic resonance is the phenomenon that contact are essential and pulse monitoring using photo- occurs when protons placed in a uniform magnetic field electric devices has been found to be satisfactory. are irradiated with pulsed radio frequency energy at the proton precessional frequency. Department of Surgery (Anaesthesia), M.J.HARRISON The signals to be detected are extremely small and are Queen's Medical Centre, easily lost in extraneous electrical noise. It has been University Hospital and Medical School, found that it is impossible with present equipment, such Clifton Boulevard, as the Diascope (Simonsen & Weel Ltd) to produce an Nottingham NG7 2UH image whilst recording the electrocardiogram. Whether the electrocardiographic machine is powered by mains Reference or battery is immaterial. An interesting interaction 1. HOLLAND GN, MOORE WS, HAWKES RC. Nuclear magnetic between the scanning equipment and the oscilloscope of resonance (NMR) tomography of the brain: coronal and the monitor is the distortion of the trace by the huge sagittal sections. Journal of Computer Assisted Tomography magnetic field. 1980; 4 429. Monitoring using methods not requiring electrical Epidural morphine I was most interested to read the three papers on the use Our studies have only involved obstetric and gynae- of epidural morphine, (Anaesthesia 1980; 35 155-63) as cological patients, and one particular brand of preser- we have some considerable experience in the use of vative-free morphine sulphate but the occurrence of morphine, pethidine, fentanyl and phenoperidine by the side-effects has been a major problem. We would be epidural route. interested to hear if any of your correspondents could We can confirm the long duration of action of throw some light on the differences between our results morphine 2-3 mg, (except in the labouring patient) but and the published 'lack of side-effects'. its use has been curtailed by the high incidence of The Woman's Hospital (Crown Street) C.B. COLLIER side-effects. These have been prolonged itching (39%pparticularly involving the face-vomiting in Surry Hills, 36% of patients and an increased incidence of post- New South Wales 2010, Australia operative retention of urine. Dr Graham and colleagues (Anaesthesia 1980; 35: 158) Originally it was thought that additives in the have reported on the long duration of postoperative morphine may have caused the problem but a specially analgesia with epidural morphine, noting the absence of prepared product has also been implicated. side-effects. This debilitating side-effect leads me to suggest that I have experience of this technique in twenty patients morphine will have to be abandoned for this procedure. after Caesarean section. Although excellent analgesia was obtained in most cases, there was a high incidence Department of Anaesthesia and BRIAN L. DUFN of severe itching which affected five patients within the Resuscitation, first 24 hours. It was variable in distribution, either The Queen Elizabeth Hospital. involving the abdomen or face or being completely Woodville, generalised. This symptom was quite distressing and South Australia SO11 lasted for up to 24 hours. Caudal epidural morphine for postoperative pain relief Epidurally applied morphine is now established as a who underwent haemorrhoidectomy (6), cystoscopy method of alleviating the pain of various conditions. It transurethral resection of the prostate and fulguration provides profound and long-lasting pain relief without (3). anal fisure (6), lateral anal sphincterectomy (I) and interference with nerve conduction. circumcision (2). We are now reporting on our initial experience with Caudal analgesia was satisfactory in all cases. The caudally applied morphine in the prevention of posto- quality of morphine analgesia subsequent to caudal perative pain. Twenty-five to 30 ml of plain bupivacaine block was assessed subjectively using a nominal scale, 0.5% with 2 mg of morphine sulphate was injected (no pain, slight pain, moderate pain, severe pain). The caudally in 18 patients aged between 18 and 74 years assessment was carried out by adifferent physician from
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Correspondence 67 Nuclear magnetic resonance is the phenomenon that contact are essential and pulse monitoring using photo- occurs when protons placed in a uniform magnetic field electric devices has been found to be satisfactory. are irradiated with pulsed radio frequency energy at the proton precessional frequency. Department of Surgery (Anaesthesia), M.J.HARRISON The signals to be detected are extremely small and are Queen's Medical Centre, easily lost in extraneous electrical noise. It has been University Hospital and Medical School, found that it is impossible with present equipment, such Clifton Boulevard, as the Diascope (Simonsen & Weel Ltd) to produce an Nottingham NG7 2UH image whilst recording the electrocardiogram. Whether the electrocardiographic machine is powered by mains Reference or battery is immaterial. An interesting interaction 1. HOLLAND GN, MOORE WS, HAWKES RC. Nuclear magnetic between the scanning equipment and the oscilloscope of resonance (NMR) tomography of the brain: coronal and the monitor is the distortion of the trace by the huge sagittal sections. Journal of Computer Assisted Tomography magnetic field. 1980; 4 429. Monitoring using methods not requiring electrical Epidural morphine I was most interested to read the three papers on the use Our studies have only involved obstetric and gynae- of epidural morphine, (Anaesthesia 1980; 35 155-63) as cological patients, and one particular brand of preser- we have some considerable experience in the use of vative-free morphine sulphate but the occurrence of morphine, pethidine, fentanyl and phenoperidine by the side-effects has been a major problem. We would be epidural route. interested to hear if any of your correspondents could We can confirm the long duration of action of throw some light on the differences between our results morphine 2-3 mg, (except in the labouring patient) but and the published 'lack of side-effects'. its use has been curtailed by the high incidence of The Woman's Hospital (Crown Street) C.B. COLLIER side-effects. These have been prolonged itching (39%pparticularly involving the face-vomiting in Surry Hills, 36% of patients and an increased incidence of post- New South Wales 2010, Australia operative retention of urine. Dr Graham and colleagues (Anaesthesia 1980; 35: 158) Originally it was thought that additives in the have reported on the long duration of postoperative morphine may have caused the problem but a specially analgesia with epidural morphine, noting the absence of prepared product has also been implicated. side-effects. This debilitating side-effect leads me to suggest that I have experience of this technique in twenty patients morphine will have to be abandoned for this procedure. after Caesarean section. Although excellent analgesia was obtained in most cases, there was a high incidence Department of Anaesthesia and BRIAN L. DUFN of severe itching which affected five patients within the Resuscitation, first 24 hours. It was variable in distribution, either The Queen Elizabeth Hospital. involving the abdomen or face or being completely Woodville, generalised. This symptom was quite distressing and South Australia SO11 lasted for up to 24 hours. Caudal epidural morphine for postoperative pain relief Epidurally applied morphine is now established as a who underwent haemorrhoidectomy (6), cystoscopy method of alleviating the pain of various conditions. It transurethral resection of the prostate and fulguration provides profound and long-lasting pain relief without (3). anal fisure (6), lateral anal sphincterectomy (I) and interference with nerve conduction. circumcision (2). We are now reporting on our initial experience with Caudal analgesia was satisfactory in all cases. The caudally applied morphine in the prevention of posto- quality of morphine analgesia subsequent to caudal perative pain. Twenty-five to 30 ml of plain bupivacaine block was assessed subjectively using a nominal scale, 0.5% with 2 mg of morphine sulphate was injected (no pain, slight pain, moderate pain, severe pain). The caudally in 18 patients aged between 18 and 74 years assessment was carried out by adifferent physician from
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