November 23, Access through your institution. Add or change institution. Save Preferences. Privacy Policy Terms of Use. Access your subscriptions. Free access to newly published articles. When compared with other analgesic possibilities, morphine could decrease the necessity of additional analgesia, which could be a real clinical advantage. However, during the last years, the utilization of opioids for the treatment of patients with AP was only partially useful because opioid, especially morphine, were from long time considered to cause dysfunction of the sphincter of Oddi when systemically administered 3 , 4.
Nonetheless, several studies, including sophisticated meta-analysis, suggest that morphine has no demonstrated significantly negative effect on the course of AP 5 - 9. In this context, whether or not morphine has a harmful effect on the evolution of AP remains still controversial in the clinic.
In a recent work Barlass and collaborators report a nice study performed in mice in which they extensively analyzed the consequences of morphine administration during the AP evolution In this study it is clearly found that treatment with morphine of mice with an experimentally induced AP exacerbates the severity of the disease with an increased pancreatic necrosis and neutrophilic infiltration in the pancreas and lung.
Unexpectedly, authors report that morphine treatment also increased AP-induced gut permeabilisation with bacterial translocation and dissemination into the studied organs i. Finally, but not less important, morphine treatment delayed macrophage infiltration, expression of some cytokines and chemokines by the pancreatic tissue as well as pancreatic regeneration Figure 1.
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This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Results: 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.
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