Side effects during continuous epidural infusion of morphine and fentanyl.

Respiratory effects, nausea, somnolence, and pruritus were compared during a 48-hr period of continuous epidural morphine (n = 34) and fentanyl (n = 32) infusion in 66 patients following elective total replacement of the hip or knee joint. Respiratory effects were assessed by PaCO2. Side effects were assessed by visual analogue scale and considered to be present when the score was above 30. Assessment was made at preoperative visits then 3, 6, 12, 24, 36, and 48 hr after the epidural injection. The bolus dose and subsequent infusion rate were 3,900 +/- 1,300 micrograms and 427 +/- 213 micrograms.hr-1 for morphine, and 85 +/- 46 micrograms and 56 +/- 27 micrograms.hr-1 for fentanyl. Pain relief was similar in both groups. In the morphine group, PaCO2 elevation and nausea occurred over a period of more than 12 hr (P less than 0.05). In the fentanyl group, there was no PaCO2 change, and nausea was confined to the first few hours. Nausea was more severe (P less than 0.01 at six hours and more frequent (24 hr cumulative incidence, 53 vs 28%, P less than 0.05) in the morphine group. Somnolence was prominent within several hours in two-thirds of patients in both groups. Somnolence continued to decline thereafter in the morphine group, but it was demonstrable in approximately half of the patients throughout the second day in the fentanyl group. The incidence was higher in the fentanyl group at the 48th hr (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical myelopathy attributable to pseudogout. Case report with radiologic, histologic, and crystallographic observations.

A 77-year-old woman complained of numbness in her hands and feet, progressive unsteadiness, weakness, and loss of proprioception of six months' duration. A myelogram revealed stenosis of the spinal canal at the levels of C2-3, T6-7, L2-3, and L3-4. On computerized tomography scan, a large dorsal, epidural, soft tissue mass and focal calcification of the ligamentum flavum were seen at C3. Laboratory studies ruled out gout, collagen disease, vitamin B12 deficiency, syphilis, parathyroid, and thyroid disease. At decompressive laminectomy, a nodular mass in the ligamentum flavum (C2-4) was found and removed. Three months after operation, the neurologic symptoms had improved. Histologic examination of the elastic ligament revealed deposits of birefringent crystals, which were identified by X-ray diffraction as calcium pyrophosphate dihydrate (CCPD). Only about six cases of myelopathy attributable to deposits of CPPD appear to have been previously reported.