Abstract
There have been conflicting reports of the value of naloxone infusions to prevent the side-effects associated with epidural morphine. In our study, 29 patients undergoing thoracotomies for pulmonary surgery received epidural morphine (0.1 mg·kg1) shortly after induction of anaesthesia. One hour after arrival in the Recovery Room, one of four naloxone bolus and infusion sequences was administered: saline bolus followed by saline infusion; 0.4 µg·kg1 naloxone bolus followed by 0.4 µg·kg-1·hr-1 naloxone infusion; 2.0 µg·kg1 naloxone bolus followed by 2.0 µg·kg-1·hr-1 naloxone infusion; and 4.0 µg·kg1 naloxone bolus followed by 4.0 µg·kg-1·hr-1 naloxone infusion.
Although with the number of patients studied, there were no statistically significant differences among groups, clinically, there was a trend toward decreased analgesia with all three naloxone infusion doses as determined by analgesic requirements, longest analgesic-free period and visual analogue pain scores. In addition, side-effects occurred in all groups. We conclude that prophylactic naloxone, used in this manner, is not an appropriate technique for the prevention of side-effects associated with epidural morphine used for the prevention of pain after thoracotomy.
Résumé
Une controverse persiste au sujet de ľutilité du naloxone dans la prévention des effets secondaires associés à la morphine en injection épidurale. Nous avons étudié 29 patients ayant subis une thoracotomie pour chirurgie pulmonaire et qui ont reçus 0.1 mg·kg-1 de morphine en injection épidurale peu aprés ľinduction de ľanesthésie. Une heure après leur arrivée à la salle de réveil, on a administré une des quatres séquences suivantes ďun bolus de naloxone suivi ďune perfusion de naloxone: bolus de salin suivi ďune perfusion de salin; bolus 0.4 µg·kg-1 de naloxone suivi ďune perfusion 0.4 µkg·hr-1 de naloxone; bolus 2.0 µg·hr-1 de naloxone suivi ďune perfusion 2.0 µ·kg-1 ·hr-1 de naloxone; bolus 4.0 µ·kg-1 de naloxone suivi ďune perfusion 4.0 µ·kg1·hr-1 de naloxone. Dû au nombre restreint de patients étudiés, les résultats ne sont pas confirmés par analyse statistique. Mais defaçon clinique, le degré ďanalgésie a été diminué avec les trois doses de naloxone tel que déterminé par le besoin ďanalgésique supplémentaire, ďespace de temps maximum entre les doses ďanalgésie requises, et t’examen des analogues visuels de la douleur. Ľincidence des effets secondaires n’a pas été modifieé. Nous concluons done que les perfusions prophylatiques de naloxone, utilisées de cette façon, ne sont pas apropriées pour prévenir les effets secondaires de la morphine en injection épidurale pour soulager la douleur après une thoracotomie.
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Gowan, J.D., Hurtig, J.B., Fraser, R.A. et al. Naloxone infusion after prophylactic epidural morphine: effects on incidence of postoperative side-effects and quality of analgesia. Can J Anaesth 35, 143–148 (1988). https://doi.org/10.1007/BF03010654
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DOI: https://doi.org/10.1007/BF03010654