Single Dose Of Epidural Morphine Research Articles

Adding Ketamine to Epidural Morphine Does Not Prolong Postoperative Analgesia After Lumbar Laminectomy or Discectomy.

Epidural opioids provide effective postoperative analgesia after lumbar spine surgery. Ketamine has been shown to reduce opioid-induced central sensitization and hyperalgesia. We hypothesized that adding ketamine to epidural opioids would prolong the duration of analgesia and enhance analgesic efficacy after lumbar spine surgery. American Society of Anesthesiologists physical status class I to II patients aged between 18 and 70 years with normal renal function undergoing lumbar laminectomy were recruited into this single-center randomized trial. Patients were randomized to receive either single-dose epidural morphine (group A) or epidural morphine and ketamine (group B) for postoperative analgesia. The primary objective was to compare the duration of analgesia as measured by time to the first postoperative analgesic request. Secondary objectives were the comparison of pain scores at rest and movement, systemic hemodynamics, and the incidence of side effects during the first 24 hours after surgery. Fifty patients were recruited (25 in each group), of which data from 48 were available for analysis. The mean±SD duration of analgesia was 20±6 and 23±3 hours in group A and group B, respectively (P=0.07). There were 12/24 (50%) patients in group A and 17/24 (71%) patients in group B who did not receive rescue analgesia during the first 24-hour postoperative period (P=0.07). Pain scores at rest and movement, systemic hemodynamics, and postoperative complications were comparable between the groups. The addition of ketamine to epidural morphine did not prolong the duration of analgesia after lumbar laminectomy.

Adverse Effects of Repeated, Intravenous Morphine on Recovery after Spinal Cord Injury in Young, Male Rats Are Blocked by a Kappa Opioid Receptor Antagonist.

Immediately following spinal cord injury (SCI) patients experience pain associated with injury to the spinal cord and nerves as well as with accompanying peripheral injuries. This pain is usually treated with opioids, and most commonly with morphine. However, in a rodent model we have shown that, irrespective of the route of administration, morphine administered in the acute phase of SCI undermines long-term locomotor recovery. Our previous data suggest that activation of kappa opioid receptors (KORs) mediates these negative effects. Blocking KORs with norbinaltorphimine (norBNI), prior to a single dose of epidural morphine, prevented the morphine-induced attenuation of locomotor recovery. Because numerous cellular changes occur with chronic opioid administration compared with a single dose, the current study tested whether norBNI was also effective in a more clinically relevant paradigm of repeated, intravenous morphine administration after SCI. We hypothesized that blocking KOR activation during repeated, intravenous morphine administration would also protect recovery. Supporting this hypothesis, we found that blocking KOR activation in young, male rats prevented the negative effects of morphine on locomotor recovery, although neither norBNI nor morphine had an effect on long-term pain at the doses used. We also found that norBNI treatment blocked the adverse effects of morphine on lesion size. These data suggest that a KOR antagonist given in conjunction with morphine may provide a clinical strategy for effective analgesia without compromising locomotor recovery after SCI.

Investigation of single-dose thoracic paravertebral analgesia for postoperative pain control after thoracoscopic lobectomy – A randomized controlled trial

BackgroundThoracoscopic lobectomy is less painful than normal thoracotomy, but pain management is still an issue in the postoperative period. Thoracic epidural analgesia (TEA) is considered as the gold standard for post-thoracotomy pain control, but is associated with numerous risks. MethodsA total of 114 patients undergoing thoracoscopic lobectomy were randomly divided into three groups. Patients in the PVB-R group received a single-dose 0.5% ropivacaine paravertebral block (PVB), combined with patient-controlled intravenous analgesia (PCIA) after extubation during the 48-h postoperative period; those in the PVB-RD group received a single-dose 0.5% ropivacaine and dexmedetomidine (1 μg/kg) PVB, combined with the same PCIA scheme; and those in the TEA group received intraoperative thoracic epidural anesthesia with 0.5% ropivacaine, and a single dose of epidural morphine (0.03 mg/kg) after extubation combined with the same PCIA scheme. The dose and first time of postoperative analgesia, verbal rating score (VRS), change in catecholamine, cortisol and cytokine levels, change in hemodynamic parameters, and side effects during the postoperative period were recorded. ResultsCompared to the PVB-R group, the dose of postoperative analgesia and VRS were lower and the first time of postoperative analgesia were longer in the PVB-RD and TEA group. Patients in the PVB-RD group had a lower incidence of side effects compared to those in the TEA group. ConclusionsSingle-dose 0.5% ropivacaine combined with dexmedetomidine (1 μg/kg) PVB provides satisfactory postoperative pain control after thoracoscopic lobectomy, and can reduce the incidence of postoperative side effects.

Comparison of the effects of different analgesic methods in elderly patients undergoing hip surgery combined with low-molecular-weight heparin

Objective To compare the effects of different analgesic methods in patients undergoing hip surgery followed by low-molecular-weight heparin administration. Methods A total of 94 ASA Ⅰ-Ⅱ patients undergoing hip surgery with combined spinal and epidural anesthesia (CSEA) who had received a single dose of 2 mg epidural morphine were randomized into 3 groups: Group M (n=30, patients receiving a single dose of epidural morphine combined with intramuscular tramadol if VAS≥4), Group E [n=34, patients receiving a single dose of epidural morphine combined with patient-controlled epidural analgesia (PCEA)], and Group I [n=30, patients receiving a single dose of epidural morphine combined with patient-controlled intravenous analgesia (PCIA)]. Infusion quantity during operation, bleeding volume and postoperative drainage volume, visual analogue scales (VAS) 24 h and 48 h after operation, Ramsay sedation scores, and nausea and vomiting were recorded. Venous blood samples were taken at admission, the end of operation, and 24 h, 48 h and 7 d after operation for hemorheological data, coagulation tests and blood platelet counts (PLT). Color Doppler ultrasonography of lower limb vessels was conducted by the same clinician before and 7 days after operation. Results VAS at 48 h after operation were higher in Group M than in Group E and Group I, and there were more patients refusing to initiate ambulation because of pain in Group M than in Group E and Group I (P 0.05). The occurrence of post-operative nausea and vomiting (PONV) was higher in Group M and Group I than in Group E (P 0.05). Conclusions A single dose of epidural morphine does not achieve satisfactory analgesia, as evidenced by a large proportion of patients refusing to initiate rehabilitation training due to pain, and the incidence of PONV is high in elderly patients undergoing hip surgery. A single dose of epidural morphine combined with PCIA offers enhanced analgesia, but it also results in increased PONV. A single dose of epidural morphine combined with PCEA provides improved analgesia and reduced PONV, but shows no added advantage with the application of low-molecular-weight heparin in deep venous thrombosis prevention. Key words: Anesthesia and analgesia; Heparin, low-molecular-weight; Arthroplasty, replacement, hip

Comparative Study of Single Dose Epidural Morphine and Intermittent Dose Morphine with Bupivacaine in Post Cesarean Analgesia

Aims: Obstetric anesthesia presents a challenge to the anesthesiologist. The effective pain management allows the parturient adequate degree of comfort and promotes physical recovery and a sense of well being. Methods: This randomized controlled study was designed to assess the analgesic efficacy and side effects of single dose direct epidural morphine (Group 1) versus intermittent 12 hourly epidural morphine with bupivacaine (Group2) for postoperative analgesia in lower segment caesarean section cases. Results: Each group consisted of 36 patients. Demographic characteristics of two groups were comparable and differences among them were not statistically significant. Mean duration of analgesia was significantly longer in group one patients (16.5 ± 2.5) in comparison to group two patients (11.5 ± 1.5). Mean highest visual analogue scales (VAS scale) was significantly lower (3.2± 0.9) in group one patients in comparison of group two (6.7±0.8) patients. Only 43% patient in group one required supplementary analgesic (Inj Paracetamole/ Diclofenac) and 71% required Inj epidural Morphine / Inj bupivacaine in group two. Mean number of supplementary analgesic required in group one was 0.7 and it was 1.8 in group two. There was no significant difference in nausea, vomiting, itching and pruritis in two groups of patients. Conclusions: our study showed that the use of single dose epidural morphine was associated with lower pain scores at rest and movement when compared to intermittent epidural morphine with bupivacaine in post-caesarean section analgesia. Single dose epidural morphine was found more convenient, less cumbersome and less costly as compared to intermittent epidural morphine for post-caesarean section analgesia. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 41-44 DOI: http://dx.doi.org/10.3126/njog.v7i1.8835

The Efficacy of 2 Doses of Epidural Morphine for Postcesarean Delivery Analgesia

A single dose of epidural morphine is effective in reducing pain after cesarean delivery but is associated with adverse effects. In this study, we sought to establish whether half the traditional dose of epidural morphine, when administered as part of a multimodal analgesia regimen after cesarean delivery, was associated with noninferior analgesia and fewer adverse effects. Ninety term parturients undergoing cesarean delivery under epidural anesthesia were enrolled in this randomized, double-blinded, noninferiority study. Patients were randomly allocated to receive either 3 mg epidural morphine or, half this dose, 1.5 mg epidural morphine. In addition, subjects received regular systemic ketorolac and acetaminophen. Rescue analgesia (oral oxycodone) was administered for breakthrough pain. The primary outcome was the difference between groups in total opioid consumption (measured in median IV morphine equivalents) within the first 24 hours. A prespecified noninferiority margin of 3.33 mg was used. Secondary outcomes included total opioid consumption from 24 to 48 hours, numerical rating scale pain scores, time to first request for analgesics, overall pain relief, maternal satisfaction, quality of recovery, and adverse effects. Data were analyzed for 87 participants. Noninferiority was demonstrated as the difference in median 24-hour opioid consumption between the 1.5 mg epidural morphine (EM) and 3 mg EM groups was 0 mg (1-sided 95% confidence interval [CI], 2.5 mg), which was less than the prespecified noninferiority margin of 3.33 mg. No significant differences were found between groups in the median 24- to 48-hour opioid consumption or the median total opioid consumption within 48 hours. Pain scores, overall pain relief, and satisfaction at 24 and 48 hours were not significantly different between groups. The 1.5 mg EM group had a lower incidence of moderate and severe pruritus at 6 and 12 hours (relative risk [RR] 0.44, 95% CI, 0.2-0.9 and RR 0.41, 95% CI, 0.2-0.8, respectively) and had less nausea and vomiting at 6 hours (RR 0.22, 95% CI, 0.05-0.9). There was no difference in average pain scores at 12 weeks between the 2 groups. When used as part of a multimodal analgesia regimen, 1.5 mg epidural morphine provided noninferior postcesarean analgesia and caused fewer adverse effects compared with 3 mg epidural morphine.

Efficacy of single dose epidural morphine versus intermittent low-dose epidural morphine along with bupivacaine for postcaesarean section analgesia.

Background:Obstetric anesthesia presents a challenge to the anesthesiologist. The effective pain management allows the partu-rient adequate degree of comfort and promotes physical reco-very and a sense of well being.Materials and Methods:This randomized controlled study was designed to assess the analgesic efficacy and side effects of 1.20 mg single-dose epidural morphine (Group 1) versus intermittent 12 hourly epidural morphine (0.5 mg) with bupivacaine (Group2) for postoperative analgesia in lower segment caesarean section cases.Results:Each group consisted of 36 patients. Demographic characteristics of two groups were comparable and differences among them were not statistically significant. Mean duration of analgesia was significantly longer in group one patients (16.5±2.5h) in comparison to group two patients (11.5±1.5h). Mean highest visual analog scales (VAS scale) was significantly lower (3.2±0.9) in group one patients in comparison of group two (6.7±0.8) patients. Only 43% patient in group one required supplementary perenteral analgesic (Paracetamole/Diclofenac) and 71% required epidural morphine/bupivacaine in group two. Mean number of supplementary perenteral analgesic required in group one was 0.7 and it was 1.8 in group two. There was no significant difference in nausea, vomiting, itching, and pruritis in two groups of patients.Conclusion:Our study showed that the use of single dose epidural morphine is associated with lower pain scores at rest and movement when compared to intermittent epidural morphine with bupivacaine in postcaesarean section analgesia.

Catatonia and jaw dislocation in the postoperative period with epidural morphine

We report a case of temporomandibular joint dislocation occurring in the postoperative period in a patient, who developed catatonia following administration of a single dose of epidural morphine. The catatonic response to epidural morphine was delayed by several hours in the postoperative period, and might have resulted from intrathecal migration of the drug, through an initial dural puncture while locating the epidural space. The temporomandibular joint dislocation was diagnosed only after reversal of the effects of morphine with naloxone, when the patient complained of inability to fully close her mouth.

Extended-release epidural morphine and postoperative nausea or vomiting

A single dose of epidural morphine can provide analgesia for up to 24 hours. Severe postoperative pain may last more than 24 hours and require repeated morphine injections or continuous infusion via an indwelling epidural catheter. Lipid-encapsulated, extended-release epidural morphine (EREM) can

A Comparison of Single-Dose Caudal Clonidine, Morphine, or Hydromorphone Combined with Ropivacaine in Pediatric Patients Undergoing Ureteral Reimplantation

Caudal blockade is a common technique for pediatric postoperative analgesia. While safe and effective, caudal opioids are associated with troublesome side effects. Caudal clonidine may offer significant analgesic benefits. We prospectively compared the analgesic, side effect, and rehabilitation profiles of caudal clonidine, hydromorphone, or morphine in a group of 60 pediatric patients undergoing ureteral reimplantation. Patients aged 6 mo to 6 yr were evenly and randomly enrolled in a double-blind manner. Patients received a single caudal dose of 2 mcg/kg of clonidine, 10 mcg/kg of hydromorphone, or 50 mcg/kg of morphine, combined with 1.0 mL/kg of 0.2% ropivacaine with epinephrine. After sevoflurane in oxygen/air anesthesia, all subjects received proxy nurse-controlled analgesia with morphine. Postoperative pain intensity, use of IV morphine, and side effects were assessed during the first 24 h. Oral intake and discharge home were recorded. Caudal clonidine resulted in less postoperative nausea and vomiting (P = 0.01) and pruritus (P = 0.007) than did caudal hydromorphone or caudal morphine. Caudal morphine produced more sustained initial analgesia than did caudal clonidine (P = 0.02). No difference was observed in pain scores, total morphine use, time to first oral intake or discharge home. No postoperative respiratory depression, excessive sedation, hypotension, or bradycardia was identified. Although caudal morphine may result in more sustained initial analgesia, caudal clonidine combined with nurse-controlled analgesia appears to provide comparable analgesia with fewer side effects. Based on these results, the use of caudal clonidine may be superior to caudal opioids after pediatric ureteral reimplantation.

Decreased Postpartum Use of Oral Pain Medication After a Single Dose of Epidural Morphine

Decreased Postpartum Use of Oral Pain Medication After a Single Dose of Epidural Morphine

Decreased postpartum use of oral pain medication after a single dose of epidural morphine

Pain after vaginal delivery may result from episiotomy, perineal laceration, or uterine involution. Many women have indwelling epidural catheters in place at delivery. We hypothesized that a small dose of epidural morphine would be an effective strategy for postpartum analgesia. Eighty-one healthy parturients receiving epidural analgesia for labor were enrolled. Patients were randomized in double-blind fashion to 1 of 3 groups: all groups received a 4-mL volume of epidural solution consisting of saline (group 1, control), 1 mg (group 2), or 2 mg morphine (group 3) after vaginal delivery. During the first 24 hours postpartum, patients were evaluated for the amount of oral pain medication requested; visual analog scale scores for pain at rest and with movement; satisfaction with postpartum pain treatment; and opioid side effects including nausea, pruritus, urinary retention, and respiratory depression. Patients who received 2 mg of epidural morphine used an average of 0.7 (0-1, interquartile range) opioid-containing pain pills (acetaminophen with codeine or oxycodone) compared with 1.2 (0-2) in the 1-mg group and 1.9 (0-3) in the control group ( P = .07). There was a statistically significant difference in oral drug usage between those who received epidural morphine and those who did not ( P < .03). There were no differences in side effects except that at 12 hours postpartum there was an increase in Foley catheterization in the 1-mg morphine group ( P = .007). These results suggest that epidural morphine decreases the need for oral pain medication in the first 24 hours postpartum. No significant dose-dependent side effects were found.

Decreased Postpartum Use of Oral Pain Medication After a Single Dose of Epidural Morphine

Decreased Postpartum Use of Oral Pain Medication After a Single Dose of Epidural Morphine

Postoperative Pain Relief After Hepatic Resection in Cirrhotic Patients: The Efficacy of a Single Small Dose of Ketamine Plus Morphine Epidurally

In cirrhotic patients undergoing hepatic surgery, postoperative analgesia remains a challenge. In this study, we evaluated the efficacy of a single dose of morphine combined with small-dose ketamine given epidurally for postoperative pain relief. One-hundred-four classification “Child A” cirrhotic patients were randomly assigned to two groups: 1) (MKG, n = 54): epidural morphine (3.5–5 mg) plus ketamine (20/30 mg); and 2) epidural morphine (3.5/5 mg) (MG, n = 50). The level of analgesia, side effects, psychomimetic and neurological disorders, additional analgesic needs, and overall quality of the analgesia were recorded. The mean duration of analgesia was longer in the MKG group (27.2 ± 8 h versus 16.4 ± 10 h;P < 0.05). In the MKG group, the visual analog scale (VAS) score began to be significantly lower from 14 h at rest and 12 h on coughing until the end of the study. The need for additional analgesia was also smaller in the MKG group (P < 0.05): at 24 h, only 10% of patients in the MKG group needed complementary analgesia, whereas in the MG group it was 100% (P = 0.003). Side effects were similar in both groups. Psychomimetic side effects and neurological disorders were not detected. These results suggest that postoperative analgesia provided by a single dose of epidural morphine with small-dose ketamine is effective in cirrhotic Child’s A patients having major upper abdominal surgery.

Droperidol and the Side Effects of Epidural Morphine After Cesarean Section

Epidural morphine produces analgesia with a high incidence of side effects that include pruritus, nausea, and vomiting.This study investigated whether epidural or IV droperidol could alleviate these symptoms. In a prospective, double-blind, randomized, controlled trial, 97 pregnant women undergoing cesarean section were randomly assigned to three groups. All received standard continuous epidural anesthesia. After delivery, each received 5 mg of epidural morphine with either no droperidol injection, 2.5 mg of epidural droperidol, or 2.5 mg of IV droperidol. The incidence, onset, duration, and severity of pruritus; the onset and severity of pain; and satisfaction were similar for each group, but the incidence and severity of nausea and vomiting was lower in the group that received IV droperidol (P < 0.01). Sedation was minimal throughout the study. Thus, epidural droperidol failed to alleviate the side effects caused by epidural morphine, but IV droperidol reduced both the incidence and severity of nausea and vomiting. These results suggest that droperidol acts systemically to counter the effects of epidural morphine but that it is not entirely effective. Implications: A single dose of epidural morphine provides long-lasting pain relief for women who have undergone cesarean section, but it has some troublesome side effects (itching, nausea, vomiting). We performed a prospective, randomized, controlled trial in 97 such women to study whether droperidol could reduce these side effects. We found that IV droperidol reduced nausea and vomiting but did not prevent itching, and that epidural droperidol failed to prevent all side effects. (Anesth Analg 1998;86:532-7)

VALUE-BASED CARE FOR PATIENTS UNDERGOING RADICAL RETROPUBIC PROSTATECTOMY

S41 The American Society of Anesthesiologists task force for value-based anesthesia care states: "The least expensive strategy for obtaining the acceptable outcome is the optimal value-based anesthetic." Recently we have implemented a clinical pathway for patients undergoing radical retropubic prostatectomy. We describe the effect of these changes on hospital costs, length of stay and patient satisfaction. Methods: The setting is a tertiary care teaching facility. The clinical pathway implemented three major changes in the care of patients undergoing radical retropubic prostatectomy. First, patients were no longer encouraged to predonate autologous blood. Second, the method of postoperative analgesia was changed from a continuous epidural infusion of 0.1% bupivicaine and 5mcg/cc fentanyl to a single dose of epidural morphine (3 or 4 mg) administered near the end of the surgery. Third, patients were encouraged to eat and ambulate as soon as the evening of surgery; postoperative nursing goals were clearly defined. Satisfaction surveys [1] were sent to all patients after surgery. Cost data were collected using the TSI billing and cost allocation system. Student's t-test with unequal variances was used to compare groups with a p<0.05 considered significant. Because there was a trend toward shorter hospital stays for patients on the clinical pathway, a stepwise linear regression was performed to determine if the mode of analgesia was independently associated with reduced cost even after the effect of shorter stays was considered. Results: Between 4/5/96 and 2/14/97, 73 patients returned complete analyzable satisfaction surveys (86% response rate). The clinical pathway was started on 9/5/96. 28 patients were on the pathway and 45 patients were not. Hospital costs, and length of stay were significantly reduced while patient satisfaction remained unchanged (Table 1). Multiple regression demonstrates that single-dose epidural morphine is associated with significantly decreased cost independent of length of stay (Table 2).Table 1: Effects of Clinical PathwayTable 2: Results of Multiple RegressionDiscussion: By developing a clinical pathway centered upon accelerated ambulation and feeding with the use of epidural morphine for postoperative analgesia we were able to significantly reduce hospital costs and length of stay in this group of patients undergoing radical retropubic prostatectomy. We were able to achieve these cost savings without negatively effecting patient satisfaction, demonstrating true value-based care.

Postcesarean Analgesia with Both Epidural Morphine and Intravenous Patient-Controlled Analgesia

Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia (PCA) with meperidine is associated with significantly more neonatal neurobehavioral depression than PCA with morphine. A single dose of epidural morphine (4 mg) decreases postcesarean opioid analgesic requirements and may reduce or prevent neonatal neurobehavioral depression associated with PCA meperidine. Prospectively, 102 term parturients underwent cesarean delivery with epidural anesthesia, 2% lidocaine and epinephrine 1:200,000. After umbilical cord clamping, each patient received epidural morphine 4 mg and was randomly allocated to receive either PCA meperidine or PCA morphine. Initial neonatal characteristics, included gestational age, Apgar scores, weight, and umbilical cord gas partial pressures. Brazelton Neonatal Behavioral Assessment Scale (NBAS) examinations were performed on each of the first 4 days of life. Nursing infants (n = 47) were grouped according to maternal PCA opioid in breast milk (meperidine [n = 24] or morphine [n = 23]); bottle-fed infants (n = 56) served as the control group. The three infant groups were equivalent with respect to initial characteristics and NBAS scores on the first 2 days of life. On the third day of life, infants in the morphine group were significantly more alert and oriented to animate human cues compared with infants in the meperidine or control group. On the fourth day of life, infants in the morphine group remained significantly more alert and oriented to animate human auditory cues than infants in the meperidine group. Average PCA opioid consumption through 48 h postpartum was equivalent (0.54 mg/kg morphine and 4.7 mg/kg meperidine); however, even with these small doses, meperidine was associated with significantly poorer neonatal alertness and orientation than morphine. Morphine is the PCA opioid of choice for postcesarean analgesia among nursing parturients. Implications: Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia with meperidine is associated with more neonatal neurobehavioral depression than patient-controlled analgesia with morphine. In this study, we found that nursing infants exposed to morphine were more alert and oriented to animate human cues than those exposed to meperidine. (Anesth Analg 1997;85:600-6)

Single-dose caudal epidural morphine in children: Safe, effective, and easy

Study Objective: To determine whether a single epidural dose of morphine sulfate is effective in providing 12- to 24-hour pain relief in children. Design: A chart review of 113 consecutive pediatric patients having received a single dose of epidural morphine. Setting: An inpatient anesthesia and surgical service at a regional children's hospital. Patients: One hundred thirteen consecutive pediatric patients from 2 months to 15 years old who underwent major orthopedic, thoracic, genitourinary, or abdominal surgical procedures. Interventions: 60 μg/kg of preservative free morphine sulfate was administered epidurally after induction of anesthesia but before surgery began. The epidural space was accessed caudally, and a total volume of 1 ml/kg to a maximum of 20 ml was injected. No other intraoperative opioids were administered. Measurements and Main Results: Forty-seven percent of the patients required no parenteral analgesic for 12 hours after receiving a single dose of epidural morphine, and only 10% required more than 0.1 mg/kg of parenteral morphine during this 12-hour period. For infants younger than 1 year of age, the supplemental intravenous (IV) morphine requirement was almost identical to that of the entire study population. There was no respiratory depression. All patients except those who had thoracotomies were followed on regular pediatric nursing floors. Conclusions: Single-dose caudal epidural morphine in children is safe and effective when administered intraoperatively prior to surgery as the only opioid and coupled with appropriate monitoring, nursing education, and follow-up by the anesthesiologist. These patients can be followed on regular nursing floors with proper monitoring.

Use of single-dose epidural morphine in a patient undergoing an abdominal aortic aneurysm resection

To avoid possible trauma to the epidural venous plexus in a 56-year-old male who presented for abdominal aortic aneurysm resection, the authors preoperatively injected a single dose of epidural morphine rather than inserting an indwelling epidural catheter. The patient's intraoperative anesthetic requirements appeared to have been decreased, he was extubated shortly after the end of the procedure, and he experienced good postoperative analgesia. No untoward neurologic sequelae occurred. The authors feel that a single dose of epidural morphine, compared to epidural catheter placement when systemic heparinization is planned, decreases intraoperahve anesthetic requirements, provides good post-operative analgesia, and may have the benefit of decreasing the possibility of epidural hematoma formation.