MYOCLONUS FOLLOWING HIGH-DOSE EPIDURAL AN D INTRAVENOUS-INFUSION OF MORPHINE

Background: Myocloni are a possible side effect of opioid therapy, and have been described following systemic as well as spinal application. Case report: We report the case of a patient with metastatic carcinom a of the rectum who developed myoclonus following administration of hi gh-dose epidural combined with iv morphine. This complication occured with maximum daily doses of 300 mg epidurally and 80 mg intravenously and disappeared completely after doses of 300 mg epidurally after dose reduction. Treatment trials are presented, the pathophysiology of the myoclonus is discussed. Conclusion: For treatment of opioid-induced m yoclonus a dose reduction or a change of the opioid should be consider ed as well as symptomatic treatment with benzodiazepines or baclofen.