Rare Morphine Technique Speeds Reagan’s Progress

President Reagan’s “spectacular postoperative course,” including his reported mental acuity after an injection of morphine, may be due in part to the manner in which the painkilling drug was administered, according to experts.

Abdominal surgery patients often are given a shot of morphine either intramuscularly or under the skin to ease their discomfort. Administered in those ways, the drug enters the bloodstream and is circulated throughout the body, including the brain.

But Reagan reportedly was given a single injection of morphine into the space that surrounds the spinal cord and through which spinal fluid flows. The dosage was about one-tenth of the amount that is traditionally used.

This technique is said to confine the numbing effects of morphine to a relatively small group of nerve endings in the spinal cord that are involved in causing the abdominal pain suffered by patients who undergo colon surgery. Partly because of the small dosage, the effects of the drug on the brain that cause grogginess are said to be less.

Called an intrathecal method of introducing drugs, this technique has been in limited use for only five or six years. Many surgeons refer to it as “very high tech,” and some of them are inclined to be skeptical about using it on their patients because of a fear that a meningitis-type of infection can occur.

This fear is based on the fact that the morphine usually is introduced into the spinal fluid by means of an “indwelling” catheter that remains in place for several days and allows morphine to drip in slowly. The presence of a catheter in such a vital area for that long provides the opportunity for germs to invade the spinal fluid, critics say.

In Reagan’s case, however, an indwelling catheter apparently was not employed, despite remarks by White House spokesman Larry Speakes on Saturday indicating that such a device had been used on the President. On Sunday, Speakes said Reagan had received only a single injection of morphine into the spinal fluid and that no device had been implanted.

Minimizing Drug’s Effects

Special concerns about minimizing the disorienting effects of morphine may explain why the intrathecal method of injection was used on the President, although it is still not widely employed, doctors said.

According to a cancer surgeon at a large federal complex here, who asked not to be identified by name, the absence of the catheter would greatly reduce the possibility of infection.

“But I would not consider him (Reagan) out of the woods yet,” he said. “Whenever you deal with colon surgery, there is the possibility of a leaking anastomosis.” The anastomosis is the place where the ends of the intestine were rejoined after the two-foot-long segment was removed from Reagan.

The surgeon said that if there is no leakage in patients within three to five days after colon surgery, anxiety over possible infection lessens.

According to the surgeon, the morphine given Reagan may be contributing to his recovery in a way other than by minimizing grogginess. Because it concentrated its effect locally on the abdominal nerves, the small dosage apparently has been sufficient to kill pain in the area while still allowing Reagan to cough and take deep breaths without feeling pain.

Coughs Help Recovery

Doctors say that coughing and breathing deeply after surgery help to prevent infections that often are the result of the collapse of the tiny air pockets in the lungs. When that happens, congestion is apt to occur, followed by infection and fever, the surgeon said. Coughing and breathing help prevent the air sacs from collapsing.

Speakes said that the President has required no other pain medication and that he was “virtually pain-free” Sunday morning. His temperature, pulse and blood pressure were normal, Speakes said.

Despite indications that he is recovering rapidly, Reagan is expected to remain in Bethesda Naval Medical Center for seven to 10 days. A typical hospitalization period for the type of surgery he had is about six days, medical experts said.