Epidural morphine following epidural local anesthesia: effect on ventilatory and airway occlusion pressure responses to CO2.

The authors measured the minute inspired ventilation (VI) and airway occlusion pressure (P 100) responses to CO2 during rebreathing in ten patients who were given epidural morphine for analgesia following lower extremity or lower abdominal surgery. All patients were studied and blood samples for morphine analysis were obtained at four different times: preoperatively, postoperatively premorphine, and one and six hours after a single 10-mg epidural dose of preservative-free morphine in 10 ml of saline. All patients reported effective analgesia with a duration ranging from 8-25.5 h. There were no differences between the pre- and postoperative VI vs. PCO2 and P100 vs. PCO2 response slopes, indicating that the epidural local anesthetic alone had no effect on respiratory drive. Administration of 10 mg morphine epidurally caused a significant 22 per cent decrease in the average VI vs. PCO2 slope and a 33 per cent decrease in the average P100 vs. PCO2 slope one hour postmorphine when compared to the postoperative slopes. The average decrease in VI vs. PCO2 at 6 h postmorphine was not significant. The average P100 vs. PCO2 response slope was decreased significantly at 6 h postmorphine by 27 per cent. There was no significant correlation between serum morphine concentration and the ventilatory responses. The authors conclude that morphine administered by the epidural route produces decreased respiratory drive and that there is a high degree of individual variability in the magnitude and time course of this effect.