naloxone and Biliary-Tract-Diseases

A randomized placebo-controlled double-blind trial was carried out in 24 patients with biliary colic pain in order to evaluate the analgesic effect of caerulein (CRL). Caerulein (1 ng/kg . min infused intravenously over 15 min) showed an analgesic effect that was significantly higher than placebo (p less than 0.001). The analgesic action of CRL was not inhibited by naloxone (0.4 mg intravenously, administered two times). Further, the effect of i.v. CRL or saline on artificially induced biliary tree hypertension was studied in 7 patients with a T-tube common bile duct drainage. During saline intravenous administration, increasing biliary tree pressure resulted in pain in 5 patients, with the threshold for pain being 40 cmH2O. During CRL intravenous infusion, significantly higher perfusion pressures were required to achieve a given common bile duct pressure and the pressure threshold for pain was not reached. Consequently, pain was prevented in all patients. These data suggest that CRL relieves biliary colic pain by reducing biliary tract pressure.

Topics: Adult; Bile Ducts; Biliary Tract Diseases; Ceruletide; Cholelithiasis; Clinical Trials as Topic; Colic; Double-Blind Method; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Naloxone; Pressure; Random Allocation; Time Factors

Spasm of the sphincter of Oddi is a well-recognized effect of the narcotic class of drugs. Although it is usually clinically silent, such spasm occasionally causes debilitating pain that may be mistaken for more serious disorders. We present the case of a patient who had undergone cholecystectomy previously, but in whom morphine given in the Emergency Department precipitated pain consistent with biliary colic; the pain resolved promptly after administration of naloxone. This entity may considered in the differential diagnosis of acute onset of colicky abdominal pain in the patient given narcotics.

Topics: Adult; Analgesics, Opioid; Biliary Tract Diseases; Cholecystectomy; Colic; Emergency Service, Hospital; Female; Humans; Morphine; Naloxone; Narcotic Antagonists; Pain; Postoperative Period; Spasm; Sphincter of Oddi

A young patient had unexpected and prolonged postoperative delirium apparently associated with morphine-induced biliary colic. Naloxone had no therapeutic effect, but a small dose of pethidine produced a dramatic return to lucidity. Unrecognized biliary spasm should be considered as a cause of agitation in the recovery room in postoperative patients who have received morphine.

Topics: Adolescent; Akathisia, Drug-Induced; Analgesics, Opioid; Anesthesia Recovery Period; Biliary Tract Diseases; Colic; Delirium; Humans; Male; Meperidine; Morphine; Naloxone; Narcotic Antagonists; Recovery Room

Topics: Adult; Biliary Tract Diseases; Butorphanol; Female; Humans; Morphinans; Naloxone; Spasm

Topics: Biliary Tract Diseases; Cholecystectomy; Colic; Female; Humans; Middle Aged; Morphine; Naloxone

In ten otherwise healthy patients undergoing cholecystectomy and cholangiography, morphine sulfate, in a dose of 2.5 mg/70 kg body weight, significantly elevated common bile duct pressure, as measured by water manometry, two and five minutes after intravenous injection. There was no added effect from an additional 7.5 mg/70 kg, measured two and five minutes after injection. Naloxone hydrochloride, in a dose of 1.0 mg/70 kg body weight, quickly reversed the increase in pressure caused by the morphine. Radiographic contrast material passed into the duodenum in every patient after administration of naloxone.

Topics: Adult; Anesthetics; Biliary Tract Diseases; Cholangiography; Cholecystectomy; Common Bile Duct; Enflurane; Female; Humans; Male; Morphine; Naloxone; Pressure

Topics: Anesthesia, Intravenous; Biliary Tract Diseases; Colic; Humans; Morphine; Naloxone