The next day, she developed a fever of 102 ☏, which gradually increased to 104 ☏ the same day. Morphine, 10 mg diluted in 10 mL of normal saline, was given slowly via the epidural catheter over 12 hours. The surgery was uneventful, the patient was transferred to the postoperative ICU, and an epidural catheter was placed to alleviate postoperative pain. Her fever subsided in the next six hours and did not happen again. She was extubated 24 hours after arriving at the ICU and was later discharged on day 10 with follow-up advice.Ī 46-year-old female with a pancreatic tumor underwent a Whipple procedure under general anesthesia. Injection morphine was replaced by paracetamol 20 mg/kg IV for analgesia. Paracetamol 10 mg/kg IV helped in reducing fever but normothermia could not be achieved. As all other causes of fever were evaluated such as infection, tumor handling, IV fluid-induced, antibiotics, and stress. Her total leukocyte count was 6,500/cu mm and C-reactive protein was 4 mg/dL. That started at 100 ☏ and sored up to 105 ☏ in the next 8 hours. While the first 12 hours were uneventful, she gradually developed a fever. She was sedated with midazolam infusion at the rate of 0.15 mg/kg/hr and intravenous (IV) morphine was administered at the rate of 0.5 mg per hour. The procedure was performed under general anesthesia as per plan, and the patient was transferred to the postoperative ICU, where she was on elective mechanical ventilation.
A pre-anesthetic evaluation was performed, and the patient was prepared for surgery. Surgery was planned after several cycles of chemotherapy had reduced the abdominal swelling to some extent. On examination, she was pale and cachectic and weighed only 12 kg. The case presentation is as per CARE guidelines.Ī previously healthy three-year-old female child was admitted to our hospital for a huge Wilms tumor of the left kidney that presented as a swelling in the left lumbar region about one year ago.
The patient or guardian provided written informed consent for publication. We conducted more than 20,000 major cases in two years and identified five patients suspected of developing a morphine-induced fever. During the two-year period, different batches of injection morphine from different manufacturers were used. Here, we describe five cases wherein patients who underwent surgery between January 2020 and December 2021 and were administered morphine for postoperative analgesia developed fevers during the postoperative period. Opioid-induced fever, especially with morphine, is an extremely rare and poorly known symptom. Opioids are the most commonly used drugs for postoperative acute pain management. Drug-induced fever is most commonly the consequence of a hypersensitivity reaction, and its features resemble those of an allergic reaction. Drug administration can cause fever by disrupting homeostasis, interfering with peripheral heat dissipation, increasing metabolism rate, inducing a cellular or humoral immune response, mimicking an endogenous pyrogen, or causing tissue damage. They are never the obvious etiological agents. Fever has myriad causes, and medications are one of them.
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