Intrathecal morphine for postoperative analgesia: Current trends

Table 5 Guidelines by American Society of Anaesthesiologists task force for the prevention, detection, and management of respiratory depression associated with intrathecal morphine administration[58,75]

Identification of patients who may have increased risk respiratory depression	Prevention of respiratory depression	Detection of respiratory depression	Treatment of respiratory depression
• History of sleep apnea or OSA • Diabetes • Obesity • Concurrent systemic opioids • History of opioid intolerance • Physical examination of airway, heart, lung, cognitive function and vital signs	• NIPPV should be used for known OSA patients • Single shot neuraxial opioid preferred over systemic continuous opioids • IT morphine is not to be given in outpatient settings • Minimal effective dose to be used • Cautious use of parenteral opioids and hypnotics in the presence of neuraxial opioid • Concomitant use of parenteral hypnotics, opioids, magnesium, or sedatives will require increased monitoring in terms of duration, intensity or additional methods	• Monitor, respiration (rate and depth), oxygenation (SaO2%) and sedation (Sedation score) • Monitor for at least 24 h every hour for the first 12 h then every 2 h for the next 12 h • After 24 h check the patient’s condition and concurrent medication and decide on frequency of monitoring	• O2 therapy when altered level of consciousness, respiratory depression, or hypoxemia • Routine O2 therapy not advised as it may prolong the duration of apneic episodes and prevent detection of atelectasis, transient apnea and hypoventilation • Use of reversal agents like naloxone •Iv access should be maintained at all times • NIPPV should be considered and initiated when there is frequent and severe airway obstruction or hypoxemia

OSA: Obstructive sleep apnea; NIPPV: Noninvasive positive pressure ventilation; iv: Intravenous.