Epidural morphine decreases postoperative hypertension by attenuating sympathetic nervous system hyperactivity
M. J. Breslow, D. A. Jordan, R. Christopherson, B. Rosenfeld, C. F. Miller, D. F. Hanley, C. Beattie, R. J. Traystman and M. C. Rogers
Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Md 21205.
Twenty-four adults who were undergoing operations on the abdominal aorta
were enrolled in a randomized, double-blind, placebo-controlled study in
which epidural morphine sulfate (6 mg) was employed to attenuate the
sympathoadrenal response to surgery to evaluate the possible contribution
of sympathetic nervous system hyperactivity to postoperative hypertension.
Patients who received epidural morphine required less parenteral morphine
in the 24 hours following surgery, had lower analogue pain scores, and had
markedly lower plasma norepinephrine levels when compared with patients in
the control group who received an identical volume of saline in the
epidural space. Epidural morphine had no effect on plasma epinephrine or
arginine vasopressin levels. Fewer patients in the morphine group (4 of 12
vs 9 of 12 patients in the saline group) required treatment for
hypertension (mean arterial blood pressure, greater than or equal to 110 mm
Hg) in the 24 hours following surgery. In addition, patients in the
morphine group had lower blood pressures in the 24 hours following surgery.
These data suggest that sympathetic nervous system activity and not adrenal
epinephrine or pituitary secretion of arginine vasopressin is responsible
for the development of hypertension following aortic surgery. Furthermore,
epidural narcotics appear to provide a means of attenuating this response.
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J Intensive Care Med 1990;5:258-291.
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POSTOPERATIVE HYPERTENSION: THE TREATMENT MAY BE ANALGESIA
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