MORPHINE AUGMENTATION INCREASES GALLBLADDER VISUALIZATION IN PATIENTSPRETREATED WITH CHOLECYSTOKININ

The purpose of this study was to determine if a combination of cholecy stokinin (CCK) pretreatment followed by morphine augmentation improved the detection of cystic duct patency compared with CCK pretreatment o nly. Methods: One hundred fifty-hive patients with suspected acute cho lecystitis had scintigraphy performed with 185-481 MBq (5-13 mCi) Tc-9 9m-mebrofenin adjusted to the patients' total bilirubin levels. All pa tients were pretreated with 0.02 mu g/kg sincalide injected intravenou sly over 3-5 min. Sequential imaging was performed until gallbladder a ctivity was identified or up to 90 min postinjection of mebrofenin. If no gallbladder was identified, a second dose of mebrofenin was given as necessary to have tracer in the biliary system. Then, 0.04 mg/kg in travenous morphine sulfate was administered, followed by imaging for u p to 30 min or until gallbladder visualization. Results: Twenty-eight percent (43/155) of the patients pretreated with CCK had nonvisualizat ion of the gallbladder at 90 min postinjection of radiotracer. After i ntravenous morphine, the gallbladder was identified in 42% (18/43) of these patients (p = 0.0001). Conclusion: Hepatobiliary imaging with CC K pretreatment and imaging for 90 min was insufficient to identify all patent cystic ducts. Morphine augmentation significantly increased th e frequency of gallbladder visualization in patients pretreated with C CK.