Morphine (Epidural)

When administered via an epidural injection, Morphine is used to facilitate a cesarean section delivery or during surgery.

Overview

As a narcotic or opioid painkiller, Morphine is an extremely potent pain reliever. By impacting directly on the central nervous system, Morphine reduces the amount of pain felt by the patient. Once administered, Morphine binds to opioid receptors and activates them. This causes analgesia (pain relief) and may induce sedation.

Although Morphine can be taken orally, administering intravenously or via intramuscular injection, it is often used as a form of epidural. This facilitates the neuroaxial application of Morphine and allows physicians to select which nerves are affected by the medication. When Morphine is administered via epidural injection, for example, it typically prevents the patient from experiencing pain sensations from the waist down.

By administering Morphine in this way, physicians can avoid having to give the patient too much medication and can prevent some side effects from occurring. Although side effects occur more commonly when Morphine is administered systemically, patients can still experience some adverse effects when Morphine has been applied via an epidural injection. Typically, however, respiratory depression and sedation occur less frequently when Morphine is given via epidural injection than when it is given intravenously.

Once injected into the epidural space in the patient's back, the medication takes effect very quickly and patients should notice their pain reducing in a matter of minutes. Due to this, Morphine can be used when urgent medical procedures are required. If an emergency cesarean needs to be performed due to complications arising from a vaginal delivery, for example, an epidural injection of Morphine can provide fast-acting analgesia and enable physicians to deliver the baby quickly.

Although Morphine can be used to facilitate an emergency cesarean section, it is also suitable for use during a planned cesarean birth. Rather than fully anesthetizing the patient, physicians can use Morphine to block the pain sensation from certain nerves. This allows the patient to remain conscious during the birth but ensures that they do not experience pain during the procedure.

In addition to this, Morphine can be used via epidural injection when patients are undergoing surgery on particular areas of their body. If full anesthesia is not viable or not required, Morphine can be used to obtain local anesthesia. Whilst patients remain conscious during the procedure, they generally have a quicker recovery time than if they had been fully sedated.

Whilst Morphine is an extremely powerful analgesic, it can be used to facilitate certain medical procedures when it is administered via epidural injection. When fast-acting pain relief or selective nerve blocks are required, Morphine can be used to minimize the patient's pain and to ensure that the necessary procedures can be carried out.

Conditions Treated

  • Pain

Type Of Medicine

  • Narcotic analgesic

Side Effects

Once Morphine has been administered, patients may experience some adverse effects. Whilst some side effects may be relatively mild, others may be more severe and could require medical intervention.

For example, patients may exhibit the following side effects after they have been given a Morphine epidural injection:

  • Full or bloated feeling
  • Lacking alertness
  • Excess gas or air in the stomach or intestines
  • Trouble with coordination
  • Fever
  • Troubled breathing with exertion
  • Headache
  • Trouble sleeping
  • Nausea
  • Back pain
  • Passing gas
  • Chest discomfort or pain
  • Skin itching
  • Pressure in the stomach
  • Nervousness or fear
  • Sleeplessness
  • Feeling unusually cold
  • Being unable to sleep
  • Pressure or pain in the stomach or lower abdomen
  • Unusual bruising or bleeding
  • Shivering
  • Crawling, burning, numbness, itching, prickling, tingling or "pins and needles' feelings
  • Pounding in the ears
  • Irregular heartbeat
  • Swelling of the stomach or abdominal area

If the above side effects are not troublesome to the patient and are fairly mild, medical assistance may not be required. However, if the patient's side effects are severe, prolonged or concerning, they should obtain medical advice.

In addition to this, patients must inform their doctor or healthcare practitioner if they experience the following side effects after being treated with Morphine:

  • Blurred vision
  • Stomach or abdominal pain or cramps
  • Confusion
  • Bloating
  • Decrease in the frequency of urination
  • Unusual weakness or tiredness
  • Decrease in urine volume
  • Sweating
  • Difficulty in passing urine (dribbling)
  • Lightheadedness, faintness or dizziness when getting up suddenly from a sitting or lying position
  • Shortness of breath
  • Drowsiness
  • Irregular, pounding or fast pulse or heartbeat
  • Painful urination
  • Wheezing
  • Pale skin
  • Vomiting
  • Constipation
  • Unconsciousness
  • Convulsions
  • Tightness in the chest
  • Diarrhea
  • Labored or difficult breathing
  • Slurred speech
  • Dry mouth
  • Slow to respond
  • Increased thirst
  • Shallow, slow, fast or irregular breathing
  • Sleepiness
  • Loss of appetite
  • Shakiness
  • Mood changes
  • Restlessness
  • Muscle cramps or pain
  • Bluish skin or lips
  • Pale or blue fingernails, lips or skin
  • Disorientation
  • Very slow breathing
  • Hallucinations
  • Unresponsiveness
  • Lethargy
  • Slowing of the heartbeat
  • Low pulse blood pressure
  • Severe drowsiness

If patients experience any other side effects after being treated with Morphine, they should also obtain medical assistance or advice.

Dosage

As an epidural injection is delivered into the patient's back via a catheter or needle, the medication will be administered by a trained healthcare practitioner. When delivering Morphine in this way, it is essential that the placement of the needle or catheter in the epidural space is verified before Morphine is injected.

When patients are given Morphine via an epidural injection, they are usually given 5mg of medication. This dose usually provides appropriate pain relief for a period of 24 hours. However, if the patient is still experiencing pain one hour after the initial dose, additional medication may be administered in increments of 1mg to 2mg. Whilst extra doses of Morphine can be used to obtain satisfactory levels of pain relief, patients should not be given more than 10mg of Morphine in a 24 hour period.

Although this is a standard dose of Morphine, patients will be assessed individually and their dose may be modified depending on their presentation, age, weight or medical history.

As Morphine must be administered by a medical professional when it is given via an epidural injection, patients will not have to calculate their own dose of medication.

Potential Drug Interactions

Due to the possibility of an unwanted interaction occurring, Morphine should not be used alongside the following medicines:

  • Naltrexone

Similarly, the use of Morphine is not usually recommended if patients are also taking or using the following medications:

  • Abiraterone
  • Estazolam
  • Acepromazine
  • Eszopiclone
  • Alfentanil
  • Ethchlorvynol
  • Alprazolam
  • Ethylmorphine
  • Alvimopan
  • Ethopropazine
  • Amiodarone
  • Linezolid
  • Amisulpride
  • Medazepam
  • Amobarbital
  • Lopinavir
  • Anileridine
  • Loxapine
  • Aripiprazole
  • Meclizine
  • Asenapine
  • Melperone
  • Azithromycin
  • Lormetazepam
  • Baclofen
  • Lorazepam
  • Benperidol
  • Lurasidone
  • Brofaromine
  • Midazolam
  • Bromazepam
  • Molindone
  • Bromopride
  • Moricizine
  • Buprenorphine
  • Methylnaltrexone
  • Buspirone
  • Morphine
  • Butabarbital
  • Moclobemide
  • Butalbital
  • Prazepam
  • Butorphanol
  • Propofol
  • Captopril
  • Prochlorperazine
  • Carbinoxamine
  • Primidone
  • Cariprazine
  • Promazine
  • Carisoprodol
  • Propoxyphene
  • Carphenazine
  • Promethazine
  • Carvedilol
  • Procarbazine
  • Chloral Hydrate
  • Paliperidone
  • Chlordiazepoxide
  • Oxymorphone
  • Chlorpromazine
  • Pentazocine
  • Chlorzoxazone
  • Paregoric
  • Cimetidine
  • Papaveretum
  • Clarithromycin
  • Pentobarbital
  • Clobazam
  • Perazine
  • Clonazepam
  • Pargyline
  • Clorazepate
  • Periciazine
  • Clorgyline
  • Quazepam
  • Clozapine
  • Phenelzine
  • Cobicistat
  • Piperacetazine
  • Codeine
  • Quercetin
  • Conivaptan
  • Perphenazine
  • Cyclobenzaprine
  • Pimavanserin
  • Cyclosporine
  • Piritramide
  • Dantrolene
  • Pipotiazine
  • Dexmedetomidine
  • Phenobarbital
  • Diacetylmorphine
  • Quetiapine
  • Dezocine
  • Pimozide
  • Diazepam
  • Sulpiride
  • Dichloralphenazone
  • Telaprevir
  • Difenoxin
  • Thiethylperazine
  • Dihydrocodeine
  • Sufentanil
  • Diltiazem
  • Sunitinib
  • Diphenhydramine
  • Thiopropazate
  • Diphenoxylate
  • Temazepam
  • Doxorubicin
  • Tapentadol
  • Doxorubicin Hydrochloride Liposome
  • Suvorexant
  • Doxylamine
  • Mesoridazine
  • Dronedarone
  • Methadone
  • Droperidol
  • Methocarbamol
  • Enflurane
  • Methdilazine
  • Erythromycin
  • Metaxalone
  • Felodipine
  • Methohexital
  • Fentanyl
  • Nicomorphine
  • Flibanserin
  • Nitrous Oxide
  • Flunitrazepam
  • Opium Alkaloids
  • Fluphenazine
  • Oxycodone
  • Flurazepam
  • Orphenadrine
  • Fluspirilene
  • Opium
  • Fospropofol
  • Olanzapine
  • Furazolidone
  • Oxazepam
  • Halazepam
  • Nitrazepam
  • Haloperidol
  • Nilotinib
  • Halothane
  • Rasagiline
  • Hexobarbital
  • Nialamide
  • Hydrocodone
  • Ramelteon
  • Hydromorphone
  • Quinidine
  • Hydroxyzine
  • Iloperidone
  • Naloxone
  • Isocarboxazid
  • Ranolazine
  • Iproniazid
  • Ritonavir
  • Isoflurane
  • Sertindole
  • Itraconazole
  • Samidorphan
  • Ivacaftor
  • Selegiline
  • Ketamine
  • Simeprevir
  • Ketazolam
  • Secobarbital
  • Ketobemidone
  • Safinamide
  • Ketoconazole
  • Ticagrelor
  • Lazabemide
  • Tocophersolan
  • Levorphanol
  • Thiothixene
  • Meperidine
  • Thioridazine
  • Mephobarbital
  • Tilidine
  • Meptazinol
  • Tizanidine
  • Methotrimeprazine
  • Toloxatone
  • Methylene Blue
  • Trifluperidol
  • Morphine Sulfate Liposome
  • Tranylcypromine
  • Nalbuphine
  • Tramadol
  • Nalmefene
  • Trifluoperazine
  • Nalorphine
  • Triazolam
  • Remifentanil
  • Zaleplon
  • Remoxipride
  • Triflupromazine
  • Risperidone
  • Trimeprazine
  • Sodium Oxybate
  • Zolpidem
  • Tolonium Chloride
  • Ziprasidone
  • Topiramate
  • Zopiclone
  • Verapamil
  • Zotepine

Similarly, patients may experience increased side effects if Morphine is used in conjunction with the following medicines:

  • Chloroprocaine
  • Somatostatin
  • Rifampin
  • Lidocaine
  • Gabapentin
  • Esmolol
  • Yohimbine
  • Epinephrine

Patients should also be aware that some medicines, such as Morphine, can interact with other substances. Due to this, patients should not consume the following substance before or after treatment with Morphine:

  • Ethanol (Alcohol)

Before being treated with Morphine, patients should tell their physician if they have used any other medicines, supplements or vitamins. Similarly, patients should obtain medical advice before using any medicines, vitamins or supplements after Morphine has been administered.

Warnings

Before undergoing treatment with Morphine, patients should disclose their medical history and current health problems to their doctor. There are some conditions with can affect the use of Morphine and these may include:

  • Breathing problems
  • Seizures
  • Pancreatitis
  • Enlarged prostate
  • Asthma
  • Heart disease
  • Low blood pressure (Hypotension)
  • Gallbladder disease
  • Sleep apnea
  • Problems with passing urine
  • Shock
  • Respiratory depression
  • Increased pressure in the head
  • Head injury
  • Paralytic ileus

When treating pediatric patients, the use of a Morphine epidural injection is not recommended.

Although geriatric patients can be treated with a Morphine epidural injection, they may have age-related conditions which could affect the use of this medication. In some cases, older patients may need to be treated with a lower than average dose of Morphine.

Once a Morphine epidural injection has begun to wear off, patients may be able to get up and walk around. However, some patients may experience lightheadedness, faintness or dizziness when they get up, particularly if they try to get up suddenly. In order to avoid this, patients should get up slowly or stay lying or sitting down until the side effects have passed.

Morphine will add to the effects of other central nervous system depressants and should not be used in conjunction with the following:

  • Alcohol
  • Sedatives
  • Anesthesia
  • Tranquilizers
  • Allergy medications
  • Seizure medications
  • Barbiturates
  • Pain medications, such as other narcotics
  • Sleeping medication
  • Antihistamines

Although a Morphine epidural injection can be used to facilitate a cesarean section delivery, it should not generally be used on pregnant patients, unless it is to deliver their baby. As a Morphine epidural injection could cause harm to the unborn fetus if used prior to the delivery, this medication should not be administered to pregnant patients unless the benefits greatly outweigh the risks.

To date, the effects of a Morphine epidural injection on breastfeeding patients have not been established. It is not known if the medication can be excreted in breast milk when it has been administered in this way or whether it would cause harm to the infant. Due to this, patients should obtain medical advice before breastfeeding if they have been given a Morphine epidural injection. Providing the medication has been expelled from the patient's system, it should no longer pose a risk.

If patients have any allergies, they should inform their physician before Morphine is administered. In rare cases, patients may develop an allergic reaction after treatment with Morphine and, if so, they will require emergency medical treatment. The symptoms of an allergic reaction may include:

  • Wheezing
  • Trouble swallowing
  • Trouble breathing
  • Hives
  • Swelling of the hands, face, throat, lips, tongue or mouth
  • Itching
  • Shortness of breath
  • Hoarseness

Storage

Generally, Morphine is supplied in single-use ampoules when it is to be used for an epidural injection and should be kept between temperatures of 20?-25?C (68?-77?F). Once opened, the ampoule should be discarded, even if some medication remains.

When patients are given Morphine via an epidural injection, it is administered by a healthcare practitioner and is usually delivered in a clinical setting, such as a treatment center or a hospital. Due to this, patients should never have to store this form of Morphine at home.

Summary

When prescribed as an epidural injection, Morphine is extremely effective in managing pain. By injecting the medication into the epidural space around the spinal cord, physicians can block pain from selected areas of the body. This is particularly useful if patients are due to undergo a surgical procedure which affects only part of their body and does not require full anesthesia.

Although Morphine is a strong narcotic, patients will be continuously monitored once they have been given an epidural injection. If further pain relief is required following the patient's procedure, Morphine may be given in oral form but epidural injections are not usually used to provide post-operative pain relief.

When administered under supervision, an epidural injection of Morphine ensures the patient can undergo the relevant procedure without experiencing any pain and that they are able to remain conscious during the procedure. As a result, patients often feel more comfortable during their surgery and generally have a relatively short recovery time.