Spinal opioids

Current Opinion in Anaesthesiology

Volumn 10, Issue 5, 1997, Pages 350-355

  Rawal, Narinder ^a  

^a ÖREBRO MEDICAL CENTRE HOSPITAL   (Sweden)

Author keywords

[No Author keywords available]

Indexed keywords

LOCAL ANESTHETIC AGENT; OPIATE;

EPIDURAL ANESTHESIA; HUMAN; LABOR; NAUSEA; OBSTETRIC ANALGESIA; PATIENT CONTROLLED ANALGESIA; POSTOPERATIVE ANALGESIA; PRIORITY JOURNAL; PRURITUS; REVIEW; SPINAL ANESTHESIA; URINE RETENTION; VOMITING;

EID: 0030838262     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001503-199710000-00014     Document Type: Review

References (32)

1. Sinatra RS, Sevarino FB: Patient-controlled analgesia with sufentanil: a comparison of two different methods of administration. J Clin Anesth 1996, 8:123-129. What is the risk-benefit ratio of PCEA? This controlled trial demonstrated that intravenous PCA with morphine is a safer, cheaper and less invasive alternative to PCEA sufentanil. The controversy continues.
2. Etches RC, Gammer TL, Cornish R: Patient-controlled epidural analgesia after thoracotomy: a comparison of meperidine with and without bupivacaine. Anesth Analg 1996, 83:81-86. Addition of bupivacaine did not offer any advantages in this study of PCEA pethidine for post-thoracotomy analgesia. Indeed, addition of local anaesthetic was associated with several side effects.
3. Cooper DW, Ryall DM, McHardy FE, Lindsay SL, Eldabe SS: Patient-controlled extradural analgesia with bupivacaine, fentanyl, or a mixture of both, after caesarean section. Br J Anaesth 1996, 76:611-615. An epidural local anaesthetic-opioid combination resulted in a low-dose reduction of bupivacaine by 68% and of fentanyl by 57%; however, no clinical benefit of this dose reduction was seen. PCEA with bupivacaine was less effective than with fentanyl.
4. Maves TJ, Gebhart GF: Antinociceptive synergy between intrathecal morphine and lidocaine during visceral and somatic nociception in the rat. Anesthesiology 1992, 76:91-99.
5. Broekema AA, Gielen MJM, Hennis PJ: Postoperative analgesia with continuous epidural sufentanil and bupivacaine: a prospective study in 614 patients. Anesth Analg 1996, 82:754-759. On the basis of their experience from over 600 patients during a 2-year period, the authors recommend an epidural bupivacaine-sufentanil combination as effective and safe on surgical wards. However, late-onset respiratory depression was noted up to 4 days after the start of treatment.
6. 2 response curves and serum morphine concentrations. The authors managed to do all this in a group that is very difficult to study. They conclude that both intravenous and epidural morphine provide effective analgesia after abdominal and genitourinary surgery but that side effects are common.
7. Carpenter RL, Abram SE, Bromage PR, Rauck RL: Consensus statement on acute pain management. Reg Anesth 1996, 21(suppl 6):152-156. A consensus statement prepared in conjunction with experts invited to a conference sponsored by the American Society of Regional Anesthesia. Excellent summary of current knowledge regarding acute pain management, quality of available data and identification of areas for future research. Highly recommended.
8. ASRA directions of acute pain management: Orlando, Florida, USA, May 31-June 2 1996. Reg Anesth 1996, 21 (suppl 6). State-of-the-art presentations by experts on the benefits and risks of regional anaesthesia and analgesia in the management of acute pain. The entire supplement is outstanding.
9. Ahn H, Bronge A, Johnsson K, Ygge H, Lindhagen J: Effect of continuous postoperative analgesia on intestinal motility. Br J Surg 1988, 75:1176-1178
10. Thorn SE, Wattwil M, Kallander A: Effects of epidural morphine and epidural bupivacaine on gastrointestinal motility during the fasted state and after food intake. Acta Anaesthesiol Scand 1994, 38:57-62.
11. Rawal N, Sjöstrand U, Christofferson E, Dahlström B, Arvill A, Rydman H: Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese: influence on postoperative ambulation and pulmonary function. Anesth Analg 1984, 63:583-592.
12. Leon-Casasola OA, Karabella D, Lema MJ: Bowel function recovery after radical hysterectomies: thoracic epidural bupivacaine-morphine versus intravenous patient-controlled analgesia with morphine: a pilot study. J Clin Anesth 1996, 8:87-92. Thoracic epidural bupivacaine-morphine after radical hysterectomy results in a decrease in duration of postoperative ileus and is associated with earlier hospital discharge.
13. Zimmerman DL, Breen TW, Fick G: Adding fentanyl 0.0002% to epidural bupivacaine 0.125% does not delay gastric emptying in laboring parturients. Anesth Analg 1996, 82:612-616.
14. Carpenter RL: Gastrointestinal benefits of regional anesthesia/analgesia. Reg Anesth 1996, 21 (suppl 6): 13-17. Excellent review of the role of regional anaesthesia, particularly the epidural technique, on postoperative gastrointestinal function.
15. Clergue F, Aissa I, Hollande J, Stephan F: Respiratory benefits of regional anesthesia. Reg Anesth 1996, 21(suppl 6):18-21. A very good review of the effects of surgery and of postoperative analgesia on respiratory function. The contradictory data regarding the role of the epidural technique in improving postoperative outcome are highlighted.
16. Major CP, Greer MS, Russell WL, Roe SM: Postoperative pulmonary complications and morbidity after abdominal aneurysmectomy: a comparison of postoperative epidural versus parenteral opioid analgesia. Am Surg 1996, 62:45-51. Retrospective data but very impressive benefits of the epidural technique after elective repair of abdominal aortic aneurysms.
17. Butterworth J, Walker F: Is spinal anesthesia produced only by local anesthetics? [Editorial]. Reg Anesth 1996, 21:81-83. This editorial discusses the role of pethidine as a local anaesthetic and opioid and updates us on its use in spinal anaesthesia, peripheral nerve blocks and intravenous regional anaesthesia.
18. Fernández-Galinski SM, Monells J, Espadaler JM, Pol O, Puig MM: Effects of subarachnoid lidocaine, meperidine and fentanyl on somatosensory and motor evoked responses in awake humans. Acta Anaesthesiol Scand 1996, 40:39-46.
19. Norris MC, Honet JE, Leighton BL, Arkoosh VA: A comparison of meperidine and lidocaine for spinal anesthesia for postpartum tubal ligation. Reg Anesth 1996, 21:84-88.
20. Cox CR, Serpell MG, Bannister J, Coventry DM, Williams DR: A comparison of epidural infusions of fentanyl or pethidine with bupivacaine in the management of postoperative pain. Anaesthesia 1996, 51:695-698.
21. Warwick DNK, Lam KK, Chen PP, Gin T: Epidural meperidine after cesarean section. A dose-response study. Anesthesiology 1996, 85:289-294. This study provides important information to those using epidural pethidine for postoperative pain management. Dose-response data show lack of any benefit when pethidine doses are above 25 mg. Considerably larger doses have been used in earlier studies.
22. Kam PCA, Tan KH: Pruritus-itching for a cause and relief? Anaesthesia 1996, 51:1133-1138. Excellent review of mechanisms of pruritus, an unpleasant irritation on the skin that provokes an urge to scratch. While antihistamines remain the first choice of treatment, recent novel treatments are also discussed.
23. Horta ML, Ramos L, da Rocha Goncalves Z, Duarte de Oliveira MA, Tonellotto D, da Silva Teixeira JP, Melo de Melo PR: Inhibition of epidural morphine-induced pruritus by intravenous droperidol. The effect of increasing the doses of morphine and of droperidol. Reg Anesth 1996, 21:312-317. Intravenous droperidol reduces the risk of epidural morphine-induced pruritus: paradoxically, a 2.5 mg dose was effective but a 5 mg dose was not.
24. Warwick JP, Kearns CF, Scott WE: The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for caesarean section. Anaesthesia 1997, 52:265-275. Some studies have demonstrated that subhypnotic doses of propofol prevent epidural opioid-induced pruritus, but not this one. In this study, 10 mg intravenous propofol was no better than intralipid (control).
25. Wang JJ, Ho ST, Yoa-Pu Hu O: Comparison of intravenous nalbuphine infusion versus saline as an adjuvant for epidural morphine. Reg Anesth 1996, 21:214-218.
26. Kendrick WD, Woods AM, Daly MY, Birch RFH, DiFazio C: Naloxone versus nalbuphine infusion for prophylaxis of epidural morphine-induced pruritus. Anesth Analg 1996, 82:641-647. In addition to comparing naloxone with nalbuphine for prophylaxis of epidural morphine-induced pruritus, the authors have also looked at several cost-related issues. Their conclusion is that wide interpatient variation in antagonist requirement argues for some form of patient-controlled therapy in order to minimize costs of interventions to manage adverse effects of epidural opioids.
27. Kitamura A, Kon T, Kamiyama M, Ogawa R: Menstrual stage influences postoperative nausea and vomiting following epidural buprenorphine. Acta Anaesthesiol Scand 1996, 40:368-371. Interesting data. Epidural buprenorphine-induced emesis is related to the menstrual cycle; emesis risk is greater during the perimenstrual stage than during the periovulatory stage.
28. Ho CM, Hseu TS, Tsai SK, Lee TY: Effect of P-6 acupressure on prevention of nausea and vomiting after epidural morphine for post-caesarean section pain relief. Acta Anaesthesiol Scand 1996, 40:372-375. Randomized, double-blind, controlled trial demonstrates convincingly that prophylactic use of acupressure bands can significantly reduce nausea and vomiting following epidural morphine.
29. Gentili M, Bonnet F: Spinal clonidine produces less urinary retention than spinal morphine. Br J Anaesth 1996, 76:872-873. The important news is not that spinal morphine causes urinary retention but that clonidine does it too, albeit to a lesser extent.
30. Kartawiadi SL, Vercauteren MP, Van Steenberge AL, Adriaensen HA: Spinal analgesia during labor with low-dose bupivacaine, sufentanil and epinephrine. A comparison with epidural analgesia. Reg Anesth 1996, 21:191-196. Subarachnoid sufentanil was superior to epidural bupivacaine for labour pain; however, the risks of side effects were also higher.
31. Nielsen PE, Randall Erickson J, Abouleish EI, Perriatt S, Sheppard C: Fetal heart rate changes after intrathecal sufentanil or epidural bupivacaine for labor analgesia: incidence and clinical significance. Anesth Analg 1996, 83:742-746. Interesting results showing that early hypotension after epidural local anaesthetic or subarachnoid sufentanil is relatively common in labouring parturients. The implications for 'walking epidurals' are discussed.
32. Milner AR, Bogod DG, Harwood RJ: Intrathecal administration of morphine for elective caesarean section. A comparison between 0.1 mg and 0.2 mg. Anaesthesia 1996, 51:871-873. This study gives a clear message: analgesia with 0.1 mg subarachnoid morphine is as good and as prolonged as that with 0.2 mg; not surprisingly, the risk of adverse effects was less with 0.1 mg morphine.