Extended-Release Epidural Morphine (DepoDur™)

Abstract

D a EPIDURAL MORPHINE HAS been administered by single and intermittent bolus doses, continuous infusion, and patient-controlled analgesia (PCA) for the management of postoperative pain for many years. All of these methods have proven to be safe and effective in controlling pain, but each also has its limitations. A single epidural injection of conventional morphine (Astramorph; AstraZeneca LP, Wilmington, DE) produces pain relief for as long as 24 hours, which may not be long enough for some patients after major surgery. Although continuous epidural infusion and patient-controlled epidural analgesia (PCEA) techniques provide prolonged relief, they require an indwelling catheter, which can impede mobility and carries the risk of intraspinal infection. In addition, guidelines for insertion and removal of indwelling epidural catheters must be carefully followed in patients receiving prophylactic anticoagulant therapy to prevent the occurrence of an epidural hematoma. However, the US Food and Drug Administration (FDA) has recently approved a unique formulation of epidural morphine called extended-release epidural morphine (EREM) (DepoDur; Endo Pharmaceuticals, Chadds Ford, PA) that may provide a better choice for pain control after some surgical procedures. A single epidural bolus of EREM is capable of providing pain relief for as long as 48 hours, which represents an exciting new postoperative pain management option for many patients undergoing major surgery.