Periarticular Morphine-Induced Sphincter of Oddi Spasm Causing Severe Pain and Bradycardia in an Awake Patient Under Spinal Anesthesia: An Important Diagnostic Consideration

A A Case Rep. 2016 Oct 1;7(7):152-4. doi: 10.1213/XAA.0000000000000372.

Abstract

Sphincter of Oddi spasm from opioids has been documented, presenting as severe epigastric pain and potentially overlooked in a differential diagnosis. We present a case of sphincter of Oddi spasm from periarticular morphine in a patient under spinal anesthesia, causing severe distress and treated effectively with glucagon. It is important for anesthesiologists using opioids to consider it as a cause of perioperative pain and be familiar with treatment as it may be refractory by conventional use of opioids for pain relief. It is also important to consider the systemic effects of periarticular absorption, as evident by our case.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects
  • Anesthesia, Spinal / methods*
  • Bradycardia / diagnostic imaging*
  • Bradycardia / etiology
  • Cartilage, Articular
  • Female
  • Humans
  • Morphine / administration & dosage
  • Morphine / adverse effects*
  • Pain / diagnostic imaging*
  • Pain / etiology
  • Severity of Illness Index
  • Spasm / chemically induced
  • Spasm / complications
  • Spasm / diagnostic imaging*
  • Sphincter of Oddi / diagnostic imaging*
  • Sphincter of Oddi / drug effects

Substances

  • Analgesics, Opioid
  • Morphine