Postoperative Epidural Opioids

Postoperative Epidural Opioids


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Postoperative Epidural Opioids by Joachim Chrubasik, Sigrun Chrubasik, Laurence Mather

Epidural opioids are widely used in the management of post-
operative pain. On the basis of an extensive review of the literature the authors here present their own interpretation of current knowledge of how the distribution and effectiveness of epidurally administered opiods are fundamentally determined.
They conclude that all opioids that are currently being used to treat postoperative epidural pain carry the potential risk of severe side effects if the dose regimens are not tailored to the patient's individual analgesic need.
This book will serve to stimulate new ideas among pain specialistst.

Product Details

ISBN-13: 9783540568711
Publisher: Springer Berlin Heidelberg
Publication date: 06/04/1993
Pages: 119
Product dimensions: 6.10(w) x 9.25(h) x (d)

Table of Contents

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.

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