Narcotic analgesic effects on the sphincter of Oddi: a review of the data and therapeutic implications in treating pancreatitis

The American Journal of Gastroenterology
D R Thompson

Abstract

Traditional teaching dictates that morphine induces "spasm" in the sphincter of Oddi (SO) and should not be used in acute pancreatitis and that meperidine is the analgesic of choice because it does not elevate SO pressures. A literature search and review was performed to evaluate this teaching examining the effect of narcotic analgesic's effects on SO. A Medline search was performed using keywords and phrases. The manufacturers of meperidine were contacted and their reports and studies were obtained and reviewed. Initial studies measured biliary pressure after narcotic administration in animals, and postoperative and intraoperative cholecystectomy patients. All narcotics increased biliary pressure, but morphine was associated with the largest elevation. Later studies using endoscopic retrograde cholangiopancreatography with direct SO manometry demonstrated that the SO is exquisitely sensitive to all narcotics including meperidine and that a small increase in biliary sphincter pressure is seen with higher doses of morphine. All narcotics increase SO phasic wave frequency and interfere with SO peristalsis. Narcotic-induced increases in phasic wave frequency interfere with SO filling and are responsible for the increase in bile du...Continue Reading

References

Sep 1, 1990·The British Journal of Surgery·A ThuneJ Toouli
Dec 1, 1988·Archives of Internal Medicine·J S Goff
Oct 1, 1988·Gut·J F HelmR C Arndorfer
Jan 1, 1984·American Journal of Surgery·R J JoehlD L Nahrwold
Feb 1, 1984·Anesthesia and Analgesia·R L McCammonJ A Madura
Apr 1, 1981·Acta Anaesthesiologica Scandinavica·I TigerstedtJ Hästbacka
Jan 1, 1994·Gastrointestinal Endoscopy·S Sherman, G A Lehman
Jan 1, 1994·Gastrointestinal Endoscopy·G H Elta, J L Barnett
Sep 1, 1996·Gastrointestinal Endoscopy·S ShermanG A Lehman
Jan 6, 1999·Journal of Clinical Pharmacy and Therapeutics·M J KendallU Martin

❮ Previous
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Citations

Oct 15, 2005·Nature Clinical Practice. Gastroenterology & Hepatology·Julia MayerleMarkus M Lerch
Feb 5, 2013·Pediatrics in Review·Arvind I Srinath, Mark E Lowe
Jun 26, 2009·World Journal of Gastroenterology : WJG·Alfredo F TonsiClaudio Bassi
May 15, 2004·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Alvin C SilvaPatrick T Liu
Feb 20, 2007·Emergency Medicine Australasia : EMA·Simone E TaylorJosephine Lugt
Aug 16, 2008·Journal of Experimental & Clinical Cancer Research : CR·Enrico M ZardiAntonella Afeltra
Jan 23, 2010·AJR. American Journal of Roentgenology·Patric KröpilDirk Blondin
Dec 7, 2016·The American Journal of Gastroenterology·Brooks D CashPaul S Covington
Mar 28, 2003·The Annals of Pharmacotherapy·Garrick P Hubbard, Kelly R Wolfe
May 11, 2017·Pediatric Annals·Monica Shukla-UdawattaDeepak Kamat
Mar 8, 2005·Journal of Pediatric Surgery·Mark Davenport, Raj Basu
Apr 15, 2005·Emergency Medicine Clinics of North America·Derek R LinklaterWesley Zeger
Jan 8, 2014·Journal of Addiction Medicine·Stije J LeopoldChristine J Weegink
May 23, 2017·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Michael CamilleriDavid A Katzka
Apr 28, 2018·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·J NeeA Lembo
Jan 20, 2018·Alimentary Pharmacology & Therapeutics·L HarinsteinA Brinker
Jul 28, 2013·The Cochrane Database of Systematic Reviews·Xavier Basurto OnaGerard Urrútia
Dec 25, 2003·Anesthesia and Analgesia·John J BatesDamian B Murphy
Feb 14, 2016·Cancer Medicine·Milica StefanovićMatthias Löhr
Jan 15, 2003·Current Pain and Headache Reports·Eric Chevlen
Jun 8, 2007·Korean Journal of Radiology : Official Journal of the Korean Radiological Society·H FarahmandM Sheikh Fathollah
Mar 14, 2009·Current Gastroenterology Reports·Alan Coss, Robert Enns
Oct 29, 2010·Gut and Liver·Hyun Cheol KooMoon Sung Lee
Aug 6, 2005·Journal of Clinical Gastroenterology·Chirag D Trivedi, C S Pitchumoni
Mar 2, 2006·Digestive Diseases·Roland H Pfutzer, Alexander Schneider
Mar 31, 2006·Annals of Hematology·Pasquale NiscolaPaolo De Fabritiis
Feb 20, 2009·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·N TeichJ Mössner
Dec 14, 2019·Laboratory Medicine·Iván González, Stephen Roper
Nov 2, 2019·Digestive Diseases and Sciences·Vijay P Singh
Nov 20, 2019·Clinical Obstetrics and Gynecology·Kristine E BrownShayna N Conner
Jan 25, 2003·European Journal of Gastroenterology & Hepatology·Urszula BłautPiotr J Thor
Mar 13, 2014·Journal of Pediatric Gastroenterology and Nutrition·Maisam Abu-El-HaijaJoseph Palermo
Feb 15, 2012·Journal of Gastroenterology and Hepatology·Julia MayerleMarkus M Lerch
Mar 1, 2014·Der Anaesthesist·M HeckerA Hecker
Apr 30, 2009·Anaesthesia and Intensive Care·W R HasibederM Dünser
Aug 9, 2003·Expert Opinion on Drug Safety·Christopher M HerndonEdwin D Dunteman
Oct 19, 2012·Medizinische Klinik, Intensivmedizin und Notfallmedizin·G Weitz
Mar 7, 2012·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Yasushi Hashimoto, L William Traverso
Jul 17, 2015·Current Opinion in Gastroenterology·John F Pohl, Aliye Uc
Jan 21, 2016·The New England Journal of Medicine·Anthony J LemboPaul S Covington
Dec 28, 2018·Alimentary Pharmacology & Therapeutics·F Garcia-GonzalezV Singh
Sep 19, 2001·Current Treatment Options in Gastroenterology·Steven L. Werlin

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