An Accidental Intrathecal Morphine Administration Associated with Total Spinal Anesthesia / 대한마취과학회지

ABSTRACT

The epidural injection on morphine is an effective method for postoperative pain management. The associated side effects have, however, precluded its widespread use in a variety of clinical settings. Intrathecal administration of morphine incurs a high incidence of pruritus, nausea and vomiting, somnolence, urinary retention and life-threatening respiratory depression in severe cases. We report here one case of accidental total spinal anesthesia with lidocaine, followed by intrathecal injection of morphine. A 39-year-old female with an ovarian tumor was scheduled for a total abdominal hysterectomy under epidural anesthesia. After the epidural space was identified erroneously, 20 ml of 2% lidocaine mixed with 1200,000 epinephrine was administered into the epidural space, immediately followed by injection of morphine 3 mg. All signs of a total spinal block were observed. She was then intubated and her respiration was controlled without delay. The schedulled operation was carried out uneventfully for 1 hour and 20 minutes. In the recovery room, a bolus injection of naloxone 0.4 mg was performed for prevention of respiratory depression. Dripping of naloxone 0.4 mg/100 ml/hour was continued for 20 hours postoperatively. However, her respiratory rate started to be decreased to 9/min around 8 hours after the surgery so that naloxone 0.2 mg was again injected intravenously. Headache and other side effects were not observed. The patient was out of ICU and discharged on the 6th postoperative day.