Canadian Journal of Anesthesia, Vol 46, 544-549, Copyright © 1999 by Canadian Anesthesiologists' Society

ARTICLES

Delayed postoperative gastric emptying following intrathecal morphine and intrathecal bupivacaine

AM Lydon, T Cooke, F Duggan and GD Shorten
Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Ireland.

PURPOSE: A decrease in the rate of gastric emptying can delay resumption of enteral feeding, alter bioavailability of orally administered drugs, and result in larger residual gastric volumes, increasing the risk of nausea and vomiting. We compared the effects of 1) intrathecal bupivacaine (17.5 mg) and 2) the combination of intrathecal morphine (0.6 mg) and intrathecal bupivacaine (17.5 mg) on the rate of gastric emptying in patients undergoing elective hip arthroplasty. METHODS: Twenty four fasting ASA 1-3 patients were randomly assigned, in a double blind manner, to receive intrathecal hyperbaric bupivacaine (17.5 mg), either alone (group 1), or followed by intrathecal morphine (0.6 mg) (group 2). Gastric emptying was measured (using an acetaminophen absorption technique), twice in each patient; preoperatively, and approximately one hour postoperatively. Gastric emptying parameters are: AUC (area under the plasma acetaminophen concentration time curve), maximum plasma acetaminophen concentration (Cmax), and time to Cmax (tCmax), analyzed using paired Student's t tests. RESULTS: Gastric emptying rates were reduced in both group 1 (AUC = 14.98 (3.8) and 11.05 (4.6) pre- and postoperatively, respectively) and group 2 (AUC = 13.93 (3.59) and 6.4 (3.42) pre- and postoperatively, respectively); the magnitude of the reduction was greater in group 2 [AUC (P = 0.04), Cmax (P = 0.05), tCmax (P = 0.13)]. CONCLUSION: The combination of intrathecal morphine (0.6 mg) and intrathecal bupivacaine (17.5 mg) delays gastric emptying postoperatively.

This article has been cited by other articles:

				I. Topcu, N. Z. Ekici, R. Isik, and M. Sakarya The effects of tramadol and fentanyl on gastrointestinal motility in septic rats. Anesth. Analg., March 1, 2006; 102(3): 876 - 881. [Abstract] [Full Text] [PDF]

				J. Wallden, S.-E. Thorn, and M. Wattwil The Delay of Gastric Emptying Induced by Remifentanil Is Not Influenced by Posture Anesth. Analg., August 1, 2004; 99(2): 429 - 434. [Abstract] [Full Text] [PDF]

				J. L. Parlow, I. Costache, N. Avery, and K. Turner Single-Dose Haloperidol for the Prophylaxis of Postoperative Nausea and Vomiting After Intrathecal Morphine Anesth. Analg., April 1, 2004; 98(4): 1072 - 1076. [Abstract] [Full Text] [PDF]

				P. M. Murphy, D. Stack, B. Kinirons, and J. G. Laffey Optimizing the Dose of Intrathecal Morphine in Older Patients Undergoing Hip Arthroplasty Anesth. Analg., December 1, 2003; 97(6): 1709 - 1715. [Abstract] [Full Text] [PDF]

				S. Ko, D. H. Goldstein, and E. G. VanDenKerkhof Definitions of "respiratory depression" with intrathecal morphine postoperative analgesia: a review of the literature: [Definitions de la "depression respiratoire" de l'analgesie postoperatoire realisee avec de la morphine intrathecale : une revue documentaire] Can J Anesth, August 1, 2003; 50(7): 679 - 688. [Abstract] [Full Text] [PDF]

				S.-A. Nortcliffe, J. Shah, and D. J. Buggy Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo Br. J. Anaesth., May 1, 2003; 90(5): 665 - 670. [Abstract] [Full Text] [PDF]

				J.-M. Devys, A. Mora, B. Plaud, C. Jayr, A. Laplanche, B. Raynard, P. Lasser, and B. Debaene Intrathecal + PCA morphine improves analgesia during the first 24 hr after major abdominal surgery compared to PCA alone: [La morphine intrathecale + la morphine en AAC, comparee a la morphine en AAC seule, ameliore l'analgesie pendant les vingt-quatre premieres heures suivant une operation abdominale majeure] Can J Anesth, April 1, 2003; 50(4): 355 - 361. [Abstract] [Full Text] [PDF]