Postoperative Epidural Opioids

ISBN-13: 9783540568711 / Angielski / Miękka / 1993 / 119 str.

Joachim Chrubasik; Sigrun Chrubasik; Laurence Mather

Opis

The authors present their own interpretation of the effectiveness of administering epidural opioids to manage post-operative pain. They conclude that all opioids carry the potential risk of severe side-effects if the dose regimens are not tailored to the patient's individual analgesic need.

Spis treści

Epidural and Intrathecal Space.- Anatomy.- Puncture of the Meninges.- Distribution of Solutions.- Determinants of Opioid Activity.- Physicochemical Properties.- Distribution and Elimination.- Opioid Receptors.- Supraspinal Receptor Sites.- Spinal Receptor Sites.- Receptor Affinities.- Receptor Binding Kinetics.- Opioid Pharmacokinetics After Epidural Administration.- Transfer Across the Meninges.- Uptake into the CSF.- Distribution within the CSF.- Elimination from CSF.- Uptake into Spinal Cord and Brain.- Uptake into Epidural Fat.- Vascular Uptake into the Systemic Circulation.- Following Epidural Bolus Injections.- During Continuous Epidural Opioid Treatment.- Elimination from Blood.- Summary.- Clinical Implications.- Onset Time of Analgesia.- Duration of Action.- Injection Volume.- Addition of Epinephrine.- Side-Effects.- Pruritus.- Urinary Retention.- Early Respiratory Depression.- Late Respiratory Depression.- Treatment.- Quality of Analgesia.- Relative to Systemic Opioids.- Injection Volume.- Addition of Local Anesthetics.- The Optimum Dosage Regimen.- Summary.- Relative Analgesic Potencies.- Definition.- Quantitation from Postoperative Dose Requirements..- Interpretation.- Summary.- Risk-Benefit Evaluation.- Morphine.- Meperidine.- Methadone.- Alfentanil.- Fentanyl.- Sufentanil.- Buprenorphine.- Tramadol.- Summary.- References.