The course of accidental epidural morphine overdose without naloxone: A case report

Author： Lu Hsiao-Feng Cheng Kwok Wai Luk Hsiang-Ning Chang Kenneth Kwok-Ang Lin Kun-Chen Jawan Bruno

ISSN： 1568-5691

Source： The Pain Clinic, Vol.16, Iss.3, 2004-08, pp. : 359-362

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Abstract

Background : Naloxone is a morphine antagonist usually given to reverse or to prevent the respiratory depression induced by morphine overdose. Case presentation : A 61-year-old man underwent a lower abdominal resection for rectal carcinoma. Epidural morphine 2 mg diluted in 10 ml of normal saline was prescribed. Twenty milligrams of morphine instead of 2 mg morphine were given by mistake. The patient was intensively observed in the post-anaesthetic room without giving naloxone for 40 hours. The respiratory rate and arterial blood gases were monitored. The respiratory rate was mildly depressed (below 16 breaths/min) for as long as 20 hours. The peak of the respiratory depression was observed after 2–3 hours with a respiratory rate of 12 breaths per minute and P_aCO₂ of 56.3 mmHg. The patient was almost 40 hours pain free. No nausea, vomiting and pruritus was noted, but urine retention was observed for 26 days.