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Epidural morphine and local anesthetics have been used as one of the most common agents for postoperative pain control. But epidural morphine has several adverse effects including respiratory depression, vomiting and nausea. This has led to attempt to combine epidural morphine administration with butorphanol or droperidol in the hope of minimizing side effects. Intravenous administration of small dose naloxone reduces epidural morphine induced side effects effectively without reversing analgesia. Choi et al. reported that epidural coadministration of morphine and naloxone reduced morphine induced side effects in dose dependent fashion without reversal of the analgesic effect. And they concluded that epidural administration of naloxone 0.167 mg/kg/hr or less could preserve analgesia while minimizing adverse effects of epidural morphine. Little is known about the optimal dose range of naloxone in the view of dose response relationship when administered into the epidural space in human subjects. We started our research to determine the optimal epidural naloxone dose range that would minimize nausea, one of the most common side effects of epidural morphine, without reversing epidural morphine induced analgesia.

The Optimal Dose Range of Epidural Naloxone to Minimize Nausea during Continuous Epidural Infusion of Morphine