Document Detail


Narcotic analgesic effects on the sphincter of Oddi: a review of the data and therapeutic implications in treating pancreatitis.
MedLine Citation:
PMID:  11316181     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Traditional teaching dictates that morphine induces "spasm" in the sphincter of Oddi (SO) and should not be used in acute pancreatitis and that meperidine is the analgesic of choice because it does not elevate SO pressures. A literature search and review was performed to evaluate this teaching examining the effect of narcotic analgesic's effects on SO. METHODS: A Medline search was performed using keywords and phrases. The manufacturers of meperidine were contacted and their reports and studies were obtained and reviewed. RESULTS: Initial studies measured biliary pressure after narcotic administration in animals, and postoperative and intraoperative cholecystectomy patients. All narcotics increased biliary pressure, but morphine was associated with the largest elevation. Later studies using endoscopic retrograde cholangiopancreatography with direct SO manometry demonstrated that the SO is exquisitely sensitive to all narcotics including meperidine and that a small increase in biliary sphincter pressure is seen with higher doses of morphine. All narcotics increase SO phasic wave frequency and interfere with SO peristalsis. CONCLUSIONS: Narcotic-induced increases in phasic wave frequency interfere with SO filling and are responsible for the increase in bile duct pressure seen on the initial studies. No studies directly compare the effects of meperidine or morphine on SO manometry and no comparative studies exist in patients with acute pancreatitis. No outcome-based studies comparing these drugs have been performed in patients with acute pancreatitis. Morphine may be of more benefit than meperidine by offering longer pain relief with less risk of seizures. No studies or evidence exist to indicate morphine is contraindicated for use in acute pancreatitis.
Authors:
D R Thompson
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  96     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2001 Apr 
Date Detail:
Created Date:  2001-04-23     Completed Date:  2001-06-28     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1266-72     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas 75246, USA.
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MeSH Terms
Descriptor/Qualifier:
Analgesics, Opioid / pharmacology*
Animals
Humans
Meperidine / pharmacology*
Morphine / pharmacology*
Narcotics / pharmacology*
Pancreatitis / drug therapy*
Sphincter of Oddi / drug effects*
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/Narcotics; 57-27-2/Morphine; 57-42-1/Meperidine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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