Morphine Local anaesthetics

Relief of pain after surgery can be achieved with a variety of techniques. An epidural infusion of a mixture of local anaesthetic and opioid provides excellent pain relief after major surgery such as laparotomy. Parenteral morphine, given intermittently by a nurse or by a patient-controlled system, will also relieve moderate or severe pain but has the attendant risk of nausea, vomiting, sedation and respiratory depression. The addition of regular paracetamol and a NSAID, given orally or rectally, will provide additional pain relief and reduce the requirement for morphine. NSAIDs are contraindicated if there is a history of gastrointestinal ulceration of if renal blood flow is compromised. 

Hesselgard K, Stromblad LG, Reinstrup P. Morphine with or without a local anaesthetic for postoperative intrathecal pain treatment after selective dorsal rhizotomy in children. Paediatr Anaesth 2001 ll(l) 75-9. 

Coc.benzoylecgo- Various local nine,A,S,morphine, anaesthetics and caffeine analgesics Analysis coc in plasma ODS-HC SIL-X-1 250x2.6 Me0H-0.05M phosphate buffer(pH 6.6)(3 1) 48... 

Chloroprocaine can reduce the efficacy of epidural morphine and fentanyl analgesia. Bupivacaine may enhance the local anaesthetic effect of fentanyl, but does not appear to affect respiration. Similarly, Udocaine does not appear to increase respiratory depressant effects of morphine. However, two cases of respiratory depression have been reported with Udocaine and opioids. Morphine given as an intravenous bolus does not alter Udocaine serum levels given as a continuous intravenous infusion. 

Meylan N, Elia N, Lysakowski C, Tramer MR. Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery meta-analysis of randomized trials. Br J Anaesth 2009 102(2) 156-67. 

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