Epidural naloxone reduces intestinal hypomotility but not analgesia of epidural morphine

被引:21
作者
Lee, J
Shim, JY
Choi, JH
Kim, ES
Kwon, OK
Moon, DE
Choi, JH
Bishop, MJ
机构
[1] Kangnam St Marys Hosp, Dept Anesthesiol, Seocho Gu, Seoul 137040, South Korea
[2] Puget Sound Vet Affairs Med Ctr, Seattle, WA USA
[3] Univ Washington, Sch Med, Seattle, WA 98195 USA
来源
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE | 2001年 / 48卷 / 01期
关键词
D O I
10.1007/BF03019815
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Purpose: Epidural morphine is associated with decreased bowel motility and increased transit time, Low doses of intravenous naloxone reduce morphine-induced pruritus without reversing analgesia, but the effect of epidural naloxone on bowel motility has not been studied. Therefore we evaluated bowel motility and analgesia when naloxone was co-administered with morphine into the epidural space. Methods: Forty-three patients having combined thoracic epidural and general anesthesia for subtotal gastrectomy were randomly assigned to one of two study groups. All received a bolus dose of 3 mg epidural morphine at the beginning of surgery, followed by a continuous epidural infusion containing 3 mg morphine in 100 mi bupivacaine 0.125% with either no naloxone (control group, n = 18) or a calculated dose of 0.208 mug.kg(-1).hr(-1) of naloxone (experimental group, n = 25) for 48 hr. We measured the time to the first postoperative passage of flatus and feces to evaluate the restoration of bowel function, and visual analog scales (VAS) for pain during rest and movement. Scores were assessed at 2, 4, 8, 16, 24, 36 and 48 hr postoperatively. Results: The experimental group had a shorter time to the first postoperative passage of flatus (51.9 +/- 16.6 hr vs 87.0 +/- 19.5 hr, P < 0.001) and feces (95.3 +/- 25.0 hr vs 132.9 +/- 29.4 hr, P < 0.001). No differences were found in either resting or active VAS between the two groups. Conclusion: Epidural naloxone reduces epidural morphine-induced intestinal hypomotility without reversing its analgesic effects.
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页码:54 / 58
页数:5
相关论文
共 23 条
[1]  
Bonnet F, 1994, Cah Anesthesiol, V42, P191
[2]   FOOTSHOCK INDUCED ANALGESIA IN MICE - ITS REVERSAL BY NALOXONE AND CROSS TOLERANCE WITH MORPHINE [J].
CHESHER, GB ;
CHAN, B .
LIFE SCIENCES, 1977, 21 (11) :1569-1573
[3]   Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine [J].
Choi, JH ;
Lee, J ;
Choi, JH ;
Bishop, MJ .
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 2000, 47 (01) :33-37
[4]  
DAHL JB, 1992, ANESTH ANALG, V74, P362
[5]   Effects of μ- and κ-opioid receptors on postoperative ileus in rats [J].
De Winter, BY ;
Boeckxstaens, GE ;
De Man, JG ;
Moreels, TG ;
Herman, AG ;
Pelckmans, PA .
EUROPEAN JOURNAL OF PHARMACOLOGY, 1997, 339 (01) :63-67
[6]   Bowel function recovery after radical hysterectomies: Thoracic epidural bupivacaine-morphine versus intravenous patient-controlled analgesia with morphine: A pilot study [J].
deLeonCasasola, OA ;
Karabella, D ;
Lema, MJ .
JOURNAL OF CLINICAL ANESTHESIA, 1996, 8 (02) :87-92
[7]  
FRAME WT, 1984, BRIT J ANAESTH, V56, P263, DOI 10.1093/bja/56.3.263
[8]   HYPERALGESIA INDUCED BY NALOXONE FOLLOWS DIURNAL RHYTHM IN RESPONSIVITY TO PAINFUL STIMULI [J].
FREDERICKSON, RCA ;
BURGIS, V ;
EDWARDS, JD .
SCIENCE, 1977, 198 (4318) :756-758
[9]   ACUTE EFFECTS OF MORPHINE AND OPIOID-PEPTIDES ON THE MOTILITY AND RESPONSES OF RAT COLON TO ELECTRICAL-STIMULATION [J].
GILLAN, MGC ;
POLLOCK, D .
BRITISH JOURNAL OF PHARMACOLOGY, 1980, 68 (03) :381-392
[10]   REFLEX ADRENERGIC INHIBITION OF GASTRIC-MOTILITY BY NOCICEPTIVE INTESTINAL STIMULATION AND PERITONEAL IRRITATION IN THE CAT [J].
GLISE, H ;
LINDAHL, BO ;
ABRAHAMSSON, H .
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 1980, 15 (06) :673-681