title: Periarticular Morphine-Induced Sphincter of Oddi Spasm Causing Severe Pain and Bradycardia in an Awake Patient Under Spinal Anesthesia: An Important Diagnostic Consideration.
abstract: Sphincter of Oddi spasm from opioids has been documented, presenting as severe epigastric pain and potentially overlooked in a differential diagnosis. We present a case of sphincter of Oddi spasm from periarticular morphine in a patient under spinal anesthesia, causing severe distress and treated effectively with glucagon. It is important for anesthesiologists using opioids to consider it as a cause of perioperative pain and be familiar with treatment as it may be refractory by conventional use of opioids for pain relief. It is also important to consider the systemic effects of periarticular absorption, as evident by our case.
authors: From the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada.
authors: Yuri
authors: Y
authors: Koumpan
authors: Dale
authors: D
authors: Engen
authors: Robert
authors: R
authors: Tanzola
authors: Tarit
authors: T
authors: Saha
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000379:methods*; D001919:Bradycardia / Q000000981:diagnostic imaging* / Q000209:etiology; D002358:Cartilage, Articular; D005260:Female; D006801:Humans; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D010146:Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D012720:Severity of Illness Index; D013035:Spasm / Q000139:chemically induced / Q000150:complications / Q000000981:diagnostic imaging*; D009803:Sphincter of Oddi / Q000000981:diagnostic imaging* / Q000187:drug effects
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine