Naloxone infusion after prophylactic epidural morphine: effects on incidence of postoperative side-effects and quality of analgesia

Can J Anaesth. 1988 Mar;35(2):143-8. doi: 10.1007/BF03010654.

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.kg-1) 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 microgram.kg-1 naloxone bolus followed by 0.4 microgram.kg-1.hr-1 naloxone infusion; 2.0 micrograms.kg-1 naloxone bolus followed by 2.0 micrograms.kg-1.hr-1 naloxone infusion; and 4.0 micrograms.kg-1 naloxone bolus followed by 4.0 micrograms.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.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Analgesia*
  • Anesthesia, Epidural* / adverse effects
  • Blood Gas Analysis
  • Clinical Trials as Topic
  • Diazepam
  • Double-Blind Method
  • Female
  • Humans
  • Isoflurane
  • Male
  • Middle Aged
  • Morphine* / adverse effects
  • Morphine* / antagonists & inhibitors
  • Naloxone / adverse effects
  • Naloxone / therapeutic use*
  • Nitrous Oxide
  • Postoperative Complications / prevention & control*
  • Preanesthetic Medication
  • Random Allocation
  • Respiratory Function Tests

Substances

  • Naloxone
  • Morphine
  • Isoflurane
  • Nitrous Oxide
  • Diazepam