J Korean Pain Soc.  1993 Nov;6(2):270-274.

Severy Respiratory Depression and Intracranial Air after Epidural Morphine: Subdural or Epidural Injection?

• Kang MG
• Moon DE
• Suh JH

Abstract

Massive extradural spread, distinguished from subarachnoid injection that sometimes follows the introduction of small amounts of local anesthetics or narcotics during attempted epidural anesthesia or analgesia, has been attributed to subdural injection. A 64-year-old woman was admitted for partial radical hysterectomy under general anesthesia after insertion of lumbar epidural cathter by loss of resistance technique with 5 ml of air. In this case, we experienced severe respiratory depression and loss of consciousness after administration of 4 mg of morphine for postoperative pain control. We confirmed air shadows at right silvian and suprasella cisterna region by CT scanning. Patients was recovered without sequele after 2 days, As this case resembles a "massive epidural", it is suggested that subdural injection rather than epidural injection may explain the phenomenon.

Keyword

Subdural injection; Respiratory depression; Epidural morphine

MeSH Terms

Analgesia
Anesthesia, Epidural
Anesthesia, General
Anesthetics, Local
Female
Humans
Hysterectomy
Injections, Epidural*
Middle Aged
Morphine*
Narcotics
Pain, Postoperative
Respiratory Insufficiency*
Tomography, X-Ray Computed
Unconsciousness
Anesthetics, Local
Morphine
Narcotics