SEIZURES AFTER CAUDAL EPIDURAL ANALGESIA – A CASE REPORT.
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Keywords
Caudal, morphine, seizures, postoperative period.
Abstract
Background: Neuroexcitation by opioids is a reported phenomenon. Many cases are reported to have seizures after the parenteral administration of opioids. Extradural administration of morphine causing seizures in the adult patient has been reported. In the current literature seizures caused by caudal morphine in the pediatric age group is nil.
Case presentation: We present a case of a 5-month-old baby who underwent open pyeloplasty under general and caudal anaesthesia. The baby was given 200 micrograms of preservative-free morphine as an additive for caudal analgesia. Around 5 hours after the caudal administration of morphine, the baby had seizures in the postoperative period. Despite antiepileptic treatment, the seizure recurred. All investigations including the neurosonogram were found to be normal. The time frame in which the seizures occurred was the first 12 hours of caudal morphine administration, which points towards neuroexcitation by morphine. And the baby needed no further antiepileptic prophylaxis when the action of morphine ceased.
Conclusion: Opioid administration in caudal space should be used cautiously and in a monitored environment only. Whenever possible avoid caudal morphine in daycare and minor cases.
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Salini Ramakrishnan
Department of Anesthesiology, Medical trust hospital, Ernakulam, Kerala.
Dr Jithil Paul
Department of Anesthesiology, Medical trust hospital, Ernakulam, Kerala.