Time course and role of morphine dose and concentration in intrathecal granuloma formation in dogs: A combined magnetic resonance imaging and histopathology investigation

Jeffrey W. Allen, Kjersti A. Horais, Nicolle A. Tozier, Kirsten Wegner, Jacqueline A. Corbeil, Robert F. Mattrey, Steven S. Rossi, Tony L. Yaksh

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Intrathecal morphine infusion leads to intrathecal granulomas. In dogs, the authors examined time course of granuloma formation and the role of concentration in granuloma development. METHODS: Dogs were prepared with lumbar intrathecal catheters and vest-mounted pumps. To define the time course of granuloma formation, serial magnetic resonance imaging was performed in animals receiving 10 or 31 days of morphine infusion (12.5 mg/ml at 40 μl/h). At these times, morphine was removed from the infusate, and further magnetic resonance images were acquired over 14-35 additional days. To assess dose versus concentration, dogs received 28-day infusions of vehicle, 12 mg morphine/day as 12.5 mg/ml at 40 μl/h, or 1.5 mg/ml at 334 μl/h (12 mg/day) for 28 days. Additional dogs received 3 mg/day as 12.5 mg/ml at 10 μl/h. RESULTS: Serial magnetic resonance images in dogs receiving morphine (12.5 mg/ml at 40 μl/h) revealed pericatheter-enhancing tissues as early as 3 days with a prominent signal by 10 days. Removal of morphine reduced the mass volume within 7 days. At a fixed infusion rate, the incidence of granuloma formation with the continuous intrathecal infusion of morphine ranged from 0 in vehicle-treated dogs to 100% in dogs treated with 12.5 mg/ml at 40 μl/h (12 mg/day). Infusion of 12 mg/day at 1.5 mg/ml (334 μl/h) resulted in granuloma in one of four animals. The authors found that infusion of morphine in different concentrations at a fixed rate resulted in a dose-dependent increase in concentration, with the granuloma-producing, dose-yielding lumbar cerebrospinal fluid morphine concentrations around 40 μg/ml. CONCLUSIONS: Serial magnetic resonance imaging showed a rapid formation and regression of the masses initiated by intrathecal morphine infusion. These masses are dependent on local concentration.

Original languageEnglish (US)
Pages (from-to)581-589
Number of pages9
JournalAnesthesiology
Volume105
Issue number3
DOIs
StatePublished - Sep 1 2006

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Granuloma
Morphine
Magnetic Resonance Imaging
Dogs
Magnetic Resonance Spectroscopy
Cerebrospinal Fluid
Catheters
Incidence

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Time course and role of morphine dose and concentration in intrathecal granuloma formation in dogs : A combined magnetic resonance imaging and histopathology investigation. / Allen, Jeffrey W.; Horais, Kjersti A.; Tozier, Nicolle A.; Wegner, Kirsten; Corbeil, Jacqueline A.; Mattrey, Robert F.; Rossi, Steven S.; Yaksh, Tony L.

In: Anesthesiology, Vol. 105, No. 3, 01.09.2006, p. 581-589.

Research output: Contribution to journalArticle

Allen, Jeffrey W. ; Horais, Kjersti A. ; Tozier, Nicolle A. ; Wegner, Kirsten ; Corbeil, Jacqueline A. ; Mattrey, Robert F. ; Rossi, Steven S. ; Yaksh, Tony L. / Time course and role of morphine dose and concentration in intrathecal granuloma formation in dogs : A combined magnetic resonance imaging and histopathology investigation. In: Anesthesiology. 2006 ; Vol. 105, No. 3. pp. 581-589.
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AU - Allen, Jeffrey W.

AU - Horais, Kjersti A.

AU - Tozier, Nicolle A.

AU - Wegner, Kirsten

AU - Corbeil, Jacqueline A.

AU - Mattrey, Robert F.

AU - Rossi, Steven S.

AU - Yaksh, Tony L.

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