J Korean Pain Soc.  1996 Jun;9(1):239-243.

Respiratory Depression during Oral MS-Contin Administration for Pain Management of Gall Bladder Cancer

• Lee CW
• Lee BH
• Lee YH

Abstract

MS-Contin is an oral controlled-release preparation of morphine sulfate that has been used widely in the management of advanced cancer pain. It prolongs plasma concentration of morphine with no observable accumulation properties following repeated dosing, thereby promoting uninterrupted sleep and hopefully improving patients quality of life. The common side effects of MS Contin are nausea, vomiting, drowsiness and constipation. But these symptoms are usually mild and respiratory depression is a rare problem. We experienced respiratory depression during oral administration of MS contin for the pain management of advanced gall bladder cancer of 76 years old male patient with metastasis at liver, intestine and cervical lymph node. After we increased the dosage of MS Contin from 160 mg to 220 mg per day, due to abdominal pain, we observed morphine reaction of MS Contin overdose such as pinpoint pupil, deeply slow respiration below 8/minute, and drowsiness. After intravenous bolus injection of 0.4 mg naloxone followed by continuous administration of 0.2 mg/hr for 4 hours, the patient regained consciousness. The administered route of morphine was changed to intravenous PCA (patient controlled analgesia). There was no aspiration sign as confirmed by chest x-ray. The patient was comfortable and delayed no signs of respiratory depression until now.

Keyword

Advanced cancer; MS contin; Respiratory depression; Naloxone

MeSH Terms

Abdominal Pain
Administration, Oral
Aged
Consciousness
Constipation
Delayed-Action Preparations
Gallbladder Neoplasms*
Humans
Intestines
Liver
Lymph Nodes
Male
Morphine
Naloxone
Nausea
Neoplasm Metastasis
Pain Management*
Passive Cutaneous Anaphylaxis
Plasma
Pupil
Quality of Life
Respiration
Respiratory Insufficiency*
Sleep Stages
Thorax
Vomiting
Delayed-Action Preparations
Morphine
Naloxone