morphine + fentanyl + hyperbaric bupivacaine ?

[ET Tube]

Hello !

Has anyone had any experience giving morphine + fentanyl + hyperbaric bupivacaine in one spinal anesthetic shot ?  I was browsing through some journals in the internet when I came across this.  They apparently used it for an abdominal surgery (sorry, I could not remember what specific surgery).

[draeger]

What was the reason for combining two opioids in one formulation?

[ET Tube]

I do not know.  I was intrigued actually.

[superkidlat]

Interesting.. My consultants when they do AAA they gave as much as 1.2 mg of morphine intrathecally but all these patients go to intensive care afterwards.

[draeger]

Interesting.. My consultants when they do AAA they gave as much as 1.2 mg of morphine intrathecally but all these patients go to intensive care afterwards.

Wow!  They do SAB for AAA?  Kinda risky isn't it?

[ET Tube]

Here we go . . .

I found the journal where they tried this out :

http://www.anesthesia-analgesia.org/cgi/content/abstract/92/3/665

By the way, in your experience, what's your intrathecal dose for morphine and fentanyl ?

I've tried 0.01 mg/kg for morphine and 1 ug/kg for fentanyl.  They seem to work just fine.  Haven't tried it in CS though . . .

[superkidlat]

Interesting.. My consultants when they do AAA they gave as much as 1.2 mg of morphine intrathecally but all these patients go to intensive care afterwards.

Wow!  They do SAB for AAA?  Kinda risky isn't it?

Nope. They do it under GAs. They just give intrathecal morphine for pain relief. They do site thoracic epidurals for the same purpose.

[draeger]

That makes more sense.

[passgas]

    I would like to share our experience in our institution.  We use Morphine + Fentanyl + Hyperbaric Bupivacaine or Morphine + Bupivacaine or Fentanyl + Bupivacaine.  In C/S, M + B is adequate and would give you the benefit of about 24-hour post-op pain control but vigilance and vital signs monitoring parameters instituted as floor/ward protocol, whereas the F + B will be sufficient for same-day surgery cases or short cases and patient is discharge on the same day.  Morphine is hydrophilic and Fentanyl is lipophilic. 
    I think the the use of Morphine without local in AAA is for post-op pain control. Also, you can use Dilaudid epidural for post-op pain relief.

[teps_12]

I KNOW OF ANES COMBINING MOSO4 AND BUPIV H FOR CHOLE. THEY USE MORP 10MG STOCK AND INSTILL INTO THE BUPIV  2-4 DROPS USING A TUBERCULIN SYRINGE. i WONDER WHAT WOULD BE THE CONVERSION OF ONE DROP IN MG!?

[POPI_CORNI]

This is what I do to intrathecal morphine to know the dose (mg) that I am actually giving. I aspirate 0.5 mg of morphine and dilute it with NSS to the 0.5 cc mark in the tuberculin syringe. this would then make a 0.1 mg/0.1 cc of the diluted morphine.