Sterility of intrathecal morphine

Started by Geoffrey Parkins, December 13, 2004, 02:24:06 AM

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Geoffrey Parkins

I have recently become a convert to IT morphine. I am using 200mcg in 2.5mL heavy bupivacaine for my spinal Cesareans. The post-op analgesia is superb and rarely requires rescue narcotic in the forst 24 hours.

I am concerned that our glass morphine ampoules are not packaged sterile. What if I am introducing bacteria simply by contaminating the morphine solution when I crack the ampoule?

So I ran an informal, personal trial. I painted the outside of the morphine ampoule with sterile methylene blue, let it dry before cracking it. About one third of the morphine solutions showed some blue discoloration from the methylene blue, indicating that a small amount of whats outside the ampoule gets inside. I now get my assistant to wipe the ampoule with alcohol (and let it dry) before they crack it.

Any other ideas?


Our hospital pharmacy makes up a sterile solution in a sterile vial of morphine 500mcg in 0.5 mL for intrathecal use. Not only is it guaranteed sterile, preservative-free, it also requires no dilution, minimising dosage errors.

George Miklos

Is morphine approved for intra-thecal use? There is certainly no mention of it on the drug insert for the brand that we use. It is approved for IV, SC, IM, intra-articular but not intra-thecal use.


In the USA, morphine is the only narcotic approved by the FDA for intrathecal and epidural use.  Off label use of other narcotics is ubiquitous.

Like Dr Parkins, our OB practice includes wide use of IT or epidural  morphine as part of our C-section anesthetics.  No one in our practice pretends to acknowledge the common opening contamination of the solution contained inside the morphine ampuile.  So far, in thousands of C-sections involving the use of morphine in non-sterilized ampules there have been no untoward effects that have been reported to us.

Didn't really occur to me until I read his post here.