Pain control with epidural injection of morphine

M. S. Chayen, V. Rudick, A. Borvine

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Abstract

The effects of postoperative and traumatic pain in Group I were very impressive, with consistent pain relief for as long as 24 hours and without noticeable side effects. The patient with the thoracotomy whose pain did not respond to treatment was probably the victim of a technical error in placing the epidural catheter, while the hysterectomy patient with the short response to the first injection and a longer response to the second probably had inadequate spread of the solution to sacral segments. In the two groups of obstetric patients, treatment was predictably less effective. If indeed the effect of the morphine occurs as a result of passage into the cerebrospinal fluid, it is reasonable to expect that the vasodilated state of the epidural space during labor would encourage systemic absorption of the morphine, so that less would pass to the cerebrospinal fluid. If one accepts a placebo response of 38%, our results in patients during labor are only slighly better, and it seems probable that very little of the morphine penetrated the dura. Patients after cesarean section might be expected to have better responses than those in labor, but perhaps for the same reasons, they might have less satisfactory responses than those in the general postoperative group. The chronic pain group, with the exception of one patient who had no response to any treatment (including intrathecal injection of phenol), showed that pain relief was consistently feasible. Each injection gave eight to 12 hours of relief for the first five days, after which it became increasingly ineffective. By the tenth day lidocaine (10 ml; 1%) provided relief of pain - followed after 30 minutes by a further morphine supplement. This restored the analgesic effect of the morphine (possibly by 'closing the gate' to pain transmission') for about five days, when a further increment of lidocaine was found necessary and was again followed by a further respite for another five days.

Original languageEnglish
Pages (from-to)338-339
Number of pages2
JournalAnesthesiology
Volume53
Issue number4
DOIs
StatePublished - 1980

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