{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:22:26Z","timestamp":1766514146904,"version":"3.40.5"},"reference-count":15,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,10,16]],"date-time":"2019-10-16T00:00:00Z","timestamp":1571184000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Epidural infusion of local anesthetics with opioids is widely used for pain control during the perioperative\u2014and peripartum\u2014periods. Selection of the opioid, appropriate dosing, and follow\u2010up by the acute pain service are critical in providing safe postoperative epidural analgesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Report Summary<\/jats:title><jats:p>A 71\u2010year\u2010old man was scheduled for a parastomal hernia repair with midline laparotomy. The parastomal hernia was a complication from a previously performed colectomy for ulcerative colitis. Preoperatively, the patient received a lower thoracic epidural catheter. The epidural infusate (0.2% ropivacaine with 0.5\u00a0\u00b5g\/<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content> sufentanil) was prepared and double\u2010checked by holding area nurses. The fact that the right prescription medication label partially covered a morphine label went unnoticed. The intraoperative phase was characterized by stable parameters. Postoperatively, it was not possible to demonstrate an epidural nerve block. No pain was reported, and the patient could be transferred to the ward. The patient developed coma and delayed respiratory depression after discharge to the surgical ward, requiring intensive care unit admission and naloxone administration. Analysis of the syringe content revealed the presence of morphine (1\u00a0mg\/<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Color\u2010coded prefilled syringes combined with the use of an epidural specific syringe connector to prevent cross\u2010connections should become standard practice. In addition, delayed respiratory depression should be considered after epidural administration of morphine.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12837","type":"journal-article","created":{"date-parts":[[2019,9,17]],"date-time":"2019-09-17T05:25:57Z","timestamp":1568697957000},"page":"321-324","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Opiate Intoxication Caused by Epidural Infusion of Morphine: A Case Report of a Near Fatal Medication Error"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5051-9407","authenticated-orcid":false,"given":"Ronald D.L.","family":"Akkerman","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Leiden University Medical Center Leiden The Netherlands"},{"name":"Department of Anesthesiology Haga Teaching Hospital The Hague The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thi M.D.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Haga Teaching Hospital The Hague The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela J.E.","family":"Dekkers","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Haga Teaching Hospital The Hague The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan A.M.","family":"de Haas","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Haga Teaching Hospital The Hague The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,10,16]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0000000000000516"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v5.i8.307"},{"key":"e_1_2_6_4_1","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1097\/ALN.0b013e31818ec946","article-title":"Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration","volume":"110","author":"American Society of Anesthesiologists Task Force on Neuraxial Opioids:","year":"2009","journal-title":"Anesthesiology"},{"key":"e_1_2_6_5_1","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1097\/ALN.0000000000000975","article-title":"Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration: an updated report by the American Society of Anesthesiologists Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicine","volume":"124","author":"American Society of Anesthesiologists Committee on Standards and Practice Parameters:","year":"2016","journal-title":"Anesthesiology"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0952-8180(94)00001-K"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200308000-00029"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12099"},{"key":"e_1_2_6_9_1","first-page":"107","article-title":"Epidural morphine anesthesia for abdominal aortic surgery\u2014pharmacokinetics","volume":"14","author":"Ionescu TI","year":"1989","journal-title":"Reg Anesth"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198712000-00003"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.2165\/11596250-000000000-00000"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198305000-00005"},{"key":"e_1_2_6_13_1","first-page":"612145","article-title":"A clinical approach to neuraxial morphine for the treatment of postoperative pain","volume":"2012","author":"Bujedo BM","year":"2012","journal-title":"Pain Res Treat"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2005.04123.x"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200012000-00025"},{"key":"e_1_2_6_16_1","unstructured":"International Standard: Small bore connectors for liquids and gases in healthcare applications\u2014Part 6: Connectors for neuraxial applications. 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