Gall Bladder
                             ============

þ Pain Meds for Gall Bladder Attacks
 - Effects of morphine on the human sphincter of Oddi In GUT, 1988,29,
   1402-1407: Morphine never caused a spasm of the muscle but increase the
   frequency of the sphincter of Oddi (SO) phasix pressure waves to a maximum
   of 10-12/min, increased phasic wave amplitude from 72 to 136 mmHg, and
   increased SO basal pressure from 10 to 29mmHg.....Although morphine does
   cause "spasm" of the human SO, its effect are more complex than is commonly
   believed.  Pharmacology of the Sphincter of Oddi Endoscopy 20 (1988)
   171-174.  Three commonly used morphine like analgesic drugs with similar
   molecular structure were studied. The study showed that one of the
   analgesic (Pentazocine) significantly raised the SO baseline pressure, but
   no spasm were induced, AND PAPILLARY MOTILITY REMAINED UNCHANGED.

þ Atropine as an adjunt for pain meds for biliary colic?
 - No.
 - "I've never used atropine, but one of the guys in my group does . . . and
   swears by it." This is what the surgeons at our institution preached
   without evidence, so we did a prospective randomized, double-blind study,
   which was published in Annals of Emergency Medicine (1993; 22:1324).
   Atropine worked no better than placebo (p=.956), and the study had adequate
   power to detect a difference.
   --Steve Green, MD  /  Loma Linda University