title: Epidural morphine injection after combined spinal and epidural anaesthesia.
abstract: OBJECTIVE
  Although combined spinal and epidural anaesthesia is efficient and easy to perform, the technique can be a double-edged sword having the potential risk that an increased flux of drugs across the meninges through the hole made in it may lead to severe adverse effects. The aim was to compare the incidence of adverse events when an epidural injection of morphine was given after combined spinal and epidural anaesthesia or after epidural anaesthesia.
  
  
  METHODS
  Fifteen patients had an epidural catheter inserted at the L2-3 interspace, and then a spinal block administered via the L3-4 interspace. Another 15 patients only had an epidural catheter inserted. After the onset of spinal or epidural anaesthesia had been confirmed, morphine 2 mg was injected into the epidural space, and a continuous epidural infusion of morphine was started. At the end of the operation and at 4, 8 and 12 h after the administration of epidural morphine and on the next day, the following variables were examined: blood pressure, heart rate, respiratory rate, arterial blood-gas analysis, visual analogue scale pain scores, nausea/vomiting scores, and pruritus scores.
  
  
  RESULTS
  In the study population, the epidural injection of morphine was not associated with a significantly higher incidence of adverse events when given after spinal anaesthesia than after epidural anaesthesia.
  
  
  CONCLUSIONS
  The adverse effects associated with epidural morphine given after spinal anaesthesia did not increase significantly when a 27-G Whitacre needle was used. Thus, the morphine flux through the meningeal hole into the cerebrospinal fluid was trivial.
authors.affiliation: Gifu University School of Medicine, Department of Anesthesiology & Critical Care Medicine, Gifu City, Japan.
authors.forename: C
authors.initials: C
authors.lastname: Takenaka-Hamaya
authors.forename: Y
authors.initials: Y
authors.lastname: Hamaya
authors.forename: S
authors.initials: S
authors.lastname: Dohi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects* / Q000627:therapeutic use; D009325:Nausea / Q000209:etiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D011537:Pruritus / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine