Epidural morphine indications

Pereira et al. (1993) evaluated postoperative pain relief and incidence of side-effects of the combination of epidural morphine (0.5 mg) and sublingual nifedipine (10 mg). In this double-blind, placebo-controlled study 36 women were submitted to elective operations (hysterectomy and colpoperineoplasty). The nifedipine-treated group showed a significant drop in blood pressure which was controlled by rehydration. The results indicate that epidural morphine-induced postoperative pain relief may be enhanced by systemic administration of nifedipine with easily controlled side-effects. 

Clinical use The indications for levobupivacaine include wound infiltration (0.25 % solution), nerve conduction block (0.25 - 0.5 %), spinal analgesia (0.5 %) and epidural anesthesia (0.5 to 0.75 %). For labour analgesia, lower concentrations of levobupivacaine are recommended when administered as epidural injection (0.125 to 0.25 % up to 25 mg) or infusion (0.25 %). The maximum dose for ilioinguinal or iliohypogastric block in children is 1.25 mg/kg/side (0.25 to 0.5 % solutions). For postoperative pain management, levobupivacaine can be applied epidurally in combination with the opioids fentanyl or morphine or with the a2-agonist clonidine. 

---