Korean J Pain.  2012 Apr;25(2):126-129. 10.3344/kjp.2012.25.2.126.

Aspiration Pneumonitis Caused by Delayed Respiratory Depression Following Intrathecal Morphine Administration

• Whang BY
• Jeong SW
• Leem JG
• Kim YK

• KMID: 1778999
• DOI: http://doi.org/10.3344/kjp.2012.25.2.126

Abstract

Opioid analgesia is the primary pharmacologic intervention for managing pain. However, opioids can cause various adverse effects including pruritus, nausea, constipation, and sedation. Respiratory depression is the most fatal side effect. Therefore, cautious monitoring of respiratory status must be done after opioid administration. Here, we report a patient who suffered from respiratory depression with deep sedation and aspiration pneumonitis after intrathecal morphine administration.

Keyword

intrathecal; morphine; pneumonitis

MeSH Terms

Analgesia
Analgesics, Opioid
Constipation
Deep Sedation
Humans
Morphine
Nausea
Pneumonia
Pruritus
Respiratory Insufficiency
Analgesics, Opioid
Morphine

Figure

• 

  Fig. 1 Chest X-ray of the patient showing multifocal patchy consolidation consistent with aspiration pneumonitis (A) and the decreased extent of pulmonary opacification in both central lung areas 3 days after initiation of the treatment (B).

Reference

1. Lee SJ, Nam SK, Kim JH, Kim HJ, Lee SC, Kim YC. Implantation of an intrathecal drug Administration system: a report of two cases. Korean J Pain. 2009; 22:68–73.

2. Rhee SM, Choi EJ, Lee PB, Nahm FS. Catheter obstruction of intrathecal drug administration system -a case report-. Korean J Pain. 2012; 25:47–51. PMID: 22259717.

3. Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth. 1995; 42:891–903. PMID: 8706199.

4. Oderda GM, Said Q, Evans RS, Stoddard GJ, Lloyd J, Jackson K, et al. Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay. Ann Pharmacother. 2007; 41:400–406. PMID: 17341537.

5. Jarzyna D, Jungquist CR, Pasero C, Willens JS, Nisbet A, Oakes L, et al. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs. 2011; 12:118–145.e10. PMID: 21893302.

6. Abou Hammoud H, Simon N, Urien S, Riou B, Lechat P, Aubrun F. Intravenous morphine titration in immediate postoperative pain management: population kinetic-pharmacodynamic and logistic regression analysis. Pain. 2009; 144:139–146. PMID: 19435651.

7. Young-McCaughan S, Miaskowski C. Definition of and mechanism for opioid-induced sedation. Pain Manag Nurs. 2001; 2:84–97. PMID: 11710090.

8. Gustafsson LL, Schildt B, Jacobsen K. Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden. Br J Anaesth. 1982; 54:479–486. PMID: 6896150.

9. Ruan X, Couch JP, Liu H, Shah RV, Wang F, Chiravuri S. Respiratory failure following delayed intrathecal morphine pump refill: a valuable, but costly lesson. Pain Physician. 2010; 13:337–341. PMID: 20648202.

10. American Society of Anesthesiologists Task Force on Neuraxial Opioids. Horlocker TT, Burton AW, Connis RT, Hughes SC, Nickinovich DG, et al. Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration. Anesthesiology. 2009; 110:218–230. PMID: 19194148.

11. Taylor S, Voytovich AE, Kozol RA. Has the pendulum swung too far in postoperative pain control? Am J Surg. 2003; 186:472–475. PMID: 14599609.