Skip to main content
Gut logoLink to Gut
. 1990 Feb;31(2):217–221. doi: 10.1136/gut.31.2.217

Sympathetic activation: a mechanism for morphine induced pain and rises in liver enzymes after cholecystectomy?

I C Roberts-Thomson 1, J R Jonsson 1, D B Frewin 1, G C Coates 1
PMCID: PMC1378384  PMID: 2311982

Abstract

In patients with biliary type pain after cholecystectomy, morphine often precipitates pain and may induce rises in plasma concentrations of liver enzymes because of exaggerated or prolonged rises in intrabiliary pressure. In this study, changes in plasma concentrations of catecholamines and histamine were determined after the administration of morphine in patients with and without a two-fold or greater rise in the plasma concentration of aspartate aminotransferase at four hours. Those showing rises in aminotransferase had higher concentrations of noradrenaline at 40 and 60 minutes after morphine and higher concentrations of dopamine at 40 minutes after morphine. The two groups had similar concentrations of adrenaline and histamine. Attempts to inhibit rises in aminotransferase after morphine by pretreatment with histamine, serotonin and alpha-receptor blockers were largely unsuccessful, although inhibition was observed with phenoxybenzamine in two of five patients. Higher plasma concentrations of noradrenaline and dopamine before and soon after induction of pain in patients showing rises in aminotransferase are consistent with sympathetic activation but heterogeneity appears to exist in the response to alpha-receptor blockade.

Full text

PDF
217

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baumgarten H. G., Lange W. Extrinsic adrenergic innervation of the extrahepatic biliary duct system in guinea-pigs, cats and rhesus monkeys. Z Zellforsch Mikrosk Anat. 1969 Sep 22;100(4):606–615. doi: 10.1007/BF00344379. [DOI] [PubMed] [Google Scholar]
  2. Bell C., Gillespie J. S., Macrae I. M. Release of noradrenaline and dopamine by nerve stimulation in the guinea-pig and rat vas deferens. Br J Pharmacol. 1984 Mar;81(3):563–569. doi: 10.1111/j.1476-5381.1984.tb10110.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cai W. Q., Gabella G. Innervation of the gall bladder and biliary pathways in the guinea-pig. J Anat. 1983 Jan;136(Pt 1):97–109. [PMC free article] [PubMed] [Google Scholar]
  4. Coelho J. C., Gouma D. J., Moody F. G., Li Y. F., Weisbrodt N. W. Influence of autonomic drugs on the motility of the sphincter of Oddi in the opossum. Surg Gynecol Obstet. 1986 Sep;163(3):209–214. [PubMed] [Google Scholar]
  5. Da Prada M., Zürcher Simultaneous radioenzymatic determination of plasma and tissue adrenaline, noradrenaline and dopamine within the femtomole range. Life Sci. 1976 Oct 15;19(8):1161–1174. doi: 10.1016/0024-3205(76)90251-4. [DOI] [PubMed] [Google Scholar]
  6. Edin R., Lundberg J., Terenius L., Dahlström A., Hökfelt T., Kewenter J., Ahlman H. Evidence for vagal enkephalinergic neural control of the feline pylorus and stomach. Gastroenterology. 1980 Mar;78(3):492–497. [PubMed] [Google Scholar]
  7. Ehrenpreis S., Kimura I., Kobayashi T., Kimura M. Histamine release as the basis for morphine action on bile duct and sphincter of Oddi. Life Sci. 1987 Apr 27;40(17):1695–1698. doi: 10.1016/0024-3205(87)90019-1. [DOI] [PubMed] [Google Scholar]
  8. Frewin D. B., Jonsson J. R., Davis K. G., Beilby A. M., Haylock D. N., Beal R. W., Russell W. J. Effect of microfiltration on the histamine levels in stored human blood. Vox Sang. 1987;52(3):191–194. doi: 10.1111/j.1423-0410.1987.tb03025.x. [DOI] [PubMed] [Google Scholar]
  9. Helm J. F., Venu R. P., Geenen J. E., Hogan W. J., Dodds W. J., Toouli J., Arndorfer R. C. Effects of morphine on the human sphincter of Oddi. Gut. 1988 Oct;29(10):1402–1407. doi: 10.1136/gut.29.10.1402. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hoeldtke R. D., Cilmi K. M., Reichard G. A., Jr, Boden G., Owen O. E. Assessment of norepinephrine secretion and production. J Lab Clin Med. 1983 May;101(5):772–782. [PubMed] [Google Scholar]
  11. Holtzer J. D., Hulst S. G. Confirmation of postcholecystectomy biliary dyskinesia by elevation of serum transaminases (GOT and GPT) after injection of morphine? Acta Med Scand. 1973;194(3):221–224. doi: 10.1111/j.0954-6820.1973.tb19435.x. [DOI] [PubMed] [Google Scholar]
  12. Jacquet Y. F. Excitatory and inhibitory effects of opiates in the rat vas deferens: a dual mechanism of opiate action. Science. 1980 Oct 3;210(4465):95–97. doi: 10.1126/science.6158098. [DOI] [PubMed] [Google Scholar]
  13. Kyösola K. Adrenergic and cholinergic innervation of the supraduodenal common bile duct. Am J Gastroenterol. 1978 Aug;70(2):179–183. [PubMed] [Google Scholar]
  14. LoGiudice J. A., Geenen J. E., Hogan W. J., Dodds W. J. Efficacy of the morphine-prostigmin test for evaluating patients with suspected papillary stenosis. Dig Dis Sci. 1979 Jun;24(6):455–458. doi: 10.1007/BF01299827. [DOI] [PubMed] [Google Scholar]
  15. Mills P. J., Dimsdale J. E. The promise of receptor studies in psychophysiologic research. Psychosom Med. 1988 Nov-Dec;50(6):555–566. doi: 10.1097/00006842-198811000-00001. [DOI] [PubMed] [Google Scholar]
  16. Northway M. G., Burks T. F. Indirect intestinal stimulatory effects of heroin: direct action on opiate receptors. Eur J Pharmacol. 1979 Nov 16;59(3-4):237–243. doi: 10.1016/0014-2999(79)90286-3. [DOI] [PubMed] [Google Scholar]
  17. Radosevich P. M., Williams P. E., Lacy D. B., McRae J. R., Steiner K. E., Cherrington A. D., Lacy W. W., Abumrad N. N. Effects of morphine on glucose homeostasis in the conscious dog. J Clin Invest. 1984 Oct;74(4):1473–1480. doi: 10.1172/JCI111560. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Roberts-Thomson I. C., Pannall P. R., Toouli J. Relationship between morphine responses and sphincter of Oddi motility in undefined biliary pain after cholecystectomy. J Gastroenterol Hepatol. 1989 Jul-Aug;4(4):317–324. doi: 10.1111/j.1440-1746.1989.tb00842.x. [DOI] [PubMed] [Google Scholar]
  19. Roberts-Thomson I. C., Toouli J. Abnormal responses to morphine-neostigmine in patients with undefined biliary type pain. Gut. 1985 Dec;26(12):1367–1372. doi: 10.1136/gut.26.12.1367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Stewart J. J., Weisbrodt N. W., Burks T. F. Central and peripheral actions of morphine on intestinal transit. J Pharmacol Exp Ther. 1978 Jun;205(3):547–555. [PubMed] [Google Scholar]
  21. Tanaka M., Ikeda S., Matsumoto S., Yoshimoto H., Nakayama F. Manometric diagnosis of sphincter of Oddi spasm as a cause of postcholecystectomy pain and the treatment by endoscopic sphincterotomy. Ann Surg. 1985 Dec;202(6):712–719. doi: 10.1097/00000658-198512000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Toouli J., Roberts-Thomson I. C., Dent J., Lee J. Manometric disorders in patients with suspected sphincter of Oddi dysfunction. Gastroenterology. 1985 May;88(5 Pt 1):1243–1250. doi: 10.1016/s0016-5085(85)80086-x. [DOI] [PubMed] [Google Scholar]
  23. Zis A. P., Haskett R. F., Albala A. A., Carroll B. J. Morphine inhibits cortisol and stimulates prolactin secretion in man. Psychoneuroendocrinology. 1984;9(4):423–427. doi: 10.1016/0306-4530(84)90050-7. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES