Epidural analgesics. How can safety and efficacy be improved?

CNS Drugs

Volumn 10, Issue 2, 1998, Pages 91-104

  Albaladejo, Pierre ^a   Bouaziz, Hervé ^b   Benhamou, Dan ^b  

^a BICÊTRE HOSPITAL   (France)

^b Hop Antoine Béclère ^*  (France)

Author keywords

[No Author keywords available]

Indexed keywords

ANALGESIC AGENT; BUPIVACAINE; CLONIDINE; ETIDOCAINE; FENTANYL; LIDOCAINE; LOCAL ANESTHETIC AGENT; METHADONE; MORPHINE; OPIATE; PETHIDINE; ROPIVACAINE; SUFENTANIL;

CARDIOTOXICITY; CATHETER; DOSE RESPONSE; DRUG BLOOD LEVEL; DRUG EFFICACY; DRUG SAFETY; EPIDURAL ANESTHESIA; EPIDURAL HEMATOMA; HEART ARRHYTHMIA; HUMAN; HYPOTENSION; INFECTION COMPLICATION; NAUSEA; NEUROMUSCULAR BLOCKING; PRIORITY JOURNAL; PRURITUS; RESPIRATION DEPRESSION; REVIEW; RISK FACTOR; SEDATION; TECHNIQUE; TOXICITY; VOMITING;

EID: 0031849148     PISSN: 11727047     EISSN: None     Source Type: Journal    
DOI: 10.2165/00023210-199810020-00002     Document Type: Review

References (94)

1. Akerman B, Hellberg IB, Trossvik C. Primary evaluation of the local anesthetic properties of the amino amide agent ropivacaine (LEA103). Acta Anaesthesiol Scand 1988; 32: 571-8
2. Covino BG. Clinical pharmacology of local anesthetic agents. In: Cousins MJ, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and management of pain. Philadelphia: JB Lippincott. 1988: 111-44
3. Agarwal R, Gutlove DP, Lockhart CH. Seizures occurring in pediatric patients receiving continuous infusion of bupivacaine. Anesth Analg 1992; 75: 284-6
4. McCloskey JJ, Haun SE, Deshpande JK. Bupivacaine toxicity secondary to continuous caudal epidural infusion in children. Anesth Analg 1992; 75: 287-90
5. Maxwell LG, Martin LD, Yaster M. Bupivacaine-induced cardiac toxicity in neonates: successful treatment with intravenous phenytoin. Anesthesiology 1994; 80: 382-6
6. Scott DB. Toxic effect of local anaesthetic agents on the central nervous system. Br J Anaeslh 1986; 58: 732-5
7. Burm AGL. Clinical pharmacokinetics of epidural and spinal anaesthesia. Clin Pharmacokinet 1989; 16: 283-311
8. Reiz S, Nath SW. Cardiotoxicity of LEA103: a new local anesthetic agent. Acta Anaesthesiol Scand 1989; 33: 93-8
9. Ross RA, Clarke JE, Armitage EW. Postoperative pain prevention by continuous epidural infusion: a study of the clinical effects and the plasma concentrations obtained. Anaesthesia 1980; 35: 663-8
10. Tucker GT. Pharmacokinetics of local anesthetics. Br J Anaesth 1986; 58: 717-31
11. Katz JA, Brindenbaugh PO, Knarr DC et al. Pharmacodynamics and pharmacokinetics of epidural ropivacaine in humans. Anesth Analg 1990; 70: 16-21
12. Cousins MJ, Bromage PR. Epidural neural blockade. In: Cousins MJ, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and management of pain. Philadelphia: JB Lippincott, 1988: 253-360
13. De Leon-Casasola OA, Parker B, Lema MJ, et al. Postoperative epidural bupivacaine-morphine therapy: experience with 4227 surgical cancer patients. Anesthesiology 1994; 81: 368-75
14. Jayr C, Thomas H, Rev A, et al. Postoperative pulmonary complications: epidural analgesia using bupivacaine and opioids versus parenteral opioids. Anesthesiology 1993; 78: 666-76
15. Leith S, Wheatly RG, Jackson IJB, et al. Extradural infusion analgesia for postoperative pain relief. Br J Anaesth 1994; 73: 552-8
16. Moiniche S, Hjortso NC, Blemmer T, et al. Blood pressure and heart rate during orthostatics stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine. Acta Anaesthesiol Scand 1993; 37: 65-9
17. Wattwil M, Sundberg A, Arvill A, et al. Circulatory changes during high thoracic epidural anesthesia: influence of sympathetic block and systemic effect of the local anesthetic. Acta Anaesthesiol Scand 1985; 29: 849-55
18. Crawford ME, Moiniche S, Orbaek J, et al. Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery. Anesth Analg 1996; 83: 1028-32
19. Goertz AW, Hübner C, Seefelder C, et al. The effect of ephedrine bolus administration on left ventricular and systolic performance during high thoracic epidural anesthesia combined with general anesthesia. Anesth Analg 1994; 78: 101-5
20. Punt CD, van Neer PAFA, de Lange S. Pressure sores as a possible complication of epidural analgesia. Anesth Analg 1991; 73: 657-9
21. Scott DB, Beilby DSN, McClymont C. Postoperative analgesia using epidural infusions of fentanyl with bupivacaine: a prospective analysis of 1014 patients. Anesthesiology 1995; 83: 727-37
22. Raj PP, Knarr DC, Vigdoth E, et al. Comparison of continuous epidural infusion of a local anesthetic and administration of systemic narcotics in the management of pain after total knee replacement surgery. Anesth Analg 1987; 66: 401-6
23. Bonica JJ. Anatomic and physiologic basis of nociception and pain. In: Bonica JJ, editor. The management of pain. 2nd ed. Philapelphia: Lea & Febiger, 1990: 28-45
24. Zaric D, Nydahl PA, Philipson L, et al. The effect of continuous lumbar epidural infusion of ropivacaine (0.1%, 0.2%, and 0.3%) and 0.25% bupivacaine on sensory and motor hlock in volunteers. Reg Anesth 1996; 21: 14-25
25. Morgan M. The rational use of intrathecal and extradural opioids. Br J Anaesth 1989; 63: 165-88
26. Sun HL, Wu CC, Lin MS, et al. Effects of epidural morphine and intramuscular diclofenac combination in postcesarean analgesia: a dose-range study. Anesth Analg 1993; 76: 284-8
27. Yee I, Carstoniu J, Halpern S, et al. A comparison of two doses of epidural fentanyl during caesarean section. Can J Anaesth 1993; 40: 722-5
28. Cohen SE, Labaille T, Benhamou D, et al. Respiratory effects of epidural sufentanil after cesarean section. Anesth Analg 1992; 74: 677-82
29. Broekema AA, Gielen MJ, Hennis PJ. Postoperative analgesia with continuous epidural sufentanil and bupivacaine: a prospective study in 614 patients. Anesth Analg 1996; 82: 754-9
30. Etches RC. Respiratory depression associated with patient-controlled analgesia: a review of eight cases. Can J Anaesth 1994; 41: 125-32
31. Wheatley RG, Somerville ID, Sapsford DJ, et al. Postoperative hypoxaemia: comparison of extradural, im, and patient-controlled opioid analgesia. Br J Anaesth 1990; 64: 267-75
32. Madej TH, Wheatley RG, Jackson IJB, et al. Hypoxaemia and pain relief after lower abdominal surgery: comparison of extradural and patient-controlled analgesia. Br J Anaesth 1992; 69: 554-7
33. Wheatley RG, Shepherd D, Jackson IJB, et al. Hypoxaemia and pain relief after upper abdominal surgery: comparison of im and patient-controlled analgesia. Br J Anaesth 1992; 69: 558-61
34. Brose WG, Cohen SE. Oxyhemoglobin saturation following cesarean section in patients receiving epidural morphine, PCA, or im meperidine analgesia. Anesthesiology 1989; 711: 948-53
35. Abouleish E, Rawal N, Rashad MN. The addition of 0.2mg subarachnoid morphine to hyperbaric bupivacaine for cesarean delivery: a prospective study of 856 cases. Reg Anesth 1991; 16: 137-40
36. Ready LB, Oden R, Chadwick HS, et al. Development of an anesthesiology-based postoperative pain management service. Anesthesiology 1988; 68: 100-6
37. Etches RC, Sandler AN, Lawson SL. A comparison of the analgesic and respiratory effects of epidural nalbuphine or morphine in post-thoracotomy patients. Anesthesiology 1991; 75: 9-14
38. Rosenberg-Adamsen S, Kehlet H, Dodds C, et al. Postoperative sleep disturbances: mechanisms and clinical implications. Br J Anaesth 1996; 76: 552-9
39. While MJ, Berghausen EJ, Dumont SW. Side effects during continuous epidural infusion of morphine and fentanyl. Can J Anaesth 1992; 39: 576-82
40. Fuller JG, McMorland GH, Douglas MJ, et al. Epidural morphine for analgesia after caesarean section: a report of 4880 patients. Can J Anaesth 1990; 37: 636-40
41. Bailey PL, Rhondeau S, Schafer PG, et al. Dose-response pharmacology of intrathecal morphine in human volunteers. Anesthesiology 1993; 79: 49-59
42. Ready LB, Lopor KA, Nessly M, et al. Postoperative epidural morphine is sate on surgical wards. Anesthesiology 1991; 75: 452-6
43. Egan KJ, Ready LB. Patient satisfaction with intravenous PCA or epidural morphine. Can J Anaesth 1994; 41: 6-11
44. Eisenach JC, Grice SC, Dewan DM. Patient-controlled analgesia following cesarean section: a comparison with epidural and intramuscular narcotics. Anesthesiology 1988; 68: 444-8
45. Thomas DA, Williams GM, Iwata K, et al. The medullary dorsal horn: a site of action of morphine in producing facial scratching in monkeys. Anesthesiology 1993; 79: 548-54
46. Saito Y, Uchida H, Kaneko M, et al. Comparison of continuous epidural infusion of morphine/bupivacaine with fentanyl/ bupivacaine for postoperative pain relief. Acta Anaesthesiol Scand 1994; 38: 398-401
47. Liu SS, Carpenter RL, Mackey DC, et al. Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 1995; 83: 757-65
48. Christie JM, Meade WR, Markowsky S. Paranoid psychosis after intrathecal morphine. Anesth Analg 1993; 77: 1298-9
49. Holder KJ, Morgan BM. Dysphoria after extradural diamorphine [letter]. Br J Anaesth 1994; 72: 728
50. Stevens RA, Sharrock NE. Nystagmus following epidural morphine. Anesthesiology 1991; 74: 390-1
51. Cohen SE, Ratner EF, Kreitzman TR, et al. Nalbuphine is better than naloxone for treatment of side effects after epidural morphine. Anesth Analg 1992; 75: 747-52
52. Bonnet F, Expert Committee. ESRA Guidelines for the use of epidural opioids. Int Monitor 1997; 9 (2): 3-8
53. Solomon RE, Gebhart GF. Synergistic antinociceptive interactions among drugs administered to the spinal cord. Anesth Analg 1994; 78: 1164-72
54. Kaneko M, Saito Y, Kirihara Y, et al. Synergistic antinociceptive interaction after epidural coadministration of morphine and lidocaine in rats. Anesthesiology 1994; 80: 137-50
55. Alahuhta S, Kangas-Saarela T, Hollmen AI, et al. Visceral pain during caesarean section under spinal and epidural anaesthesia with bupivacaine. Acta Anaesthesiol Scand 1990; 34: 95-8
56. Courtney MA, Bader AM, Hartwell B, et al. Perioperative analgesia with subarachnoid sufentanil administration. Reg Anesth 1992; 17: 274-8
57. Scott NB, Mogensen T, Bigler D, et al. Continuous thoracic extradural 0.5% bupivacaine with or without morphine: effect on quality of blockade, lung function and the surgical stress response. Br J Anaesth 1989; 62: 253-7
58. Dahl JB, Rosenberg J, Hansen BL, et al. Differential analgesic effects of low-dose epidural morphine and morphine-bupivacaine at rest and during mobilization after major abdominal surgery. Anest Analg 1992; 74: 362-5
59. Martin R, Salbaing J, Blaise G, et al. Epidural morphine tor postoperative pain relief: a dose-response curve. Anesthesiology 1982; 56: 423-6
60. Rosen MA, Hughes SC, Shnider SM, et al. Epidural morphine for the relief of postoperative pain after cesarean delivery. Anesth Analg 1983; 62: 666-72
61. Yamaguchi H, Watanabe S, Harukuni I, et al. Effective doses of epidural morphine tor relief of postcholecystectomy pain. Anest Analg 1991; 72: 80-3
62. Lanz E, Kehrberger E, Theiss D. Epidural morphine: a clinical double-blind study ot dosage. Anesth Analg 1985; 64: 786-91
63. Allen PD, Walman T, Concepcion M, et al. Epidural morphine provides postoperative pain relief in peripheral vascular and orthopedic surgical patients: a dose-response study. Anesth Analg 1986; 65: 165-70
64. Rauck RL, Prithvi Raj P, Knarr DC, et al. Comparison of the efficacy of epidural morphine given by intermittent injection or continuous infusion for the management of postoperative pain. Reg Anesth 1994; 19: 316-24
65. Chisakuta AM, George KA. Postoperative epidural infusion of a mixture of bupivacame 0.2% with fentanyl for upper abdominal surgery. Anaesthesia 1995; 50: 72-5
66. Højkjær Larsen V, Iversen AD, Christensen P, et al. Postoperative pain treatment after upper abdominal surgery with epidural morphine at thoracic or lumbar level. Acta Anesthesiol Scand 1985; 29: 566-71
67. Loper KE, Ready LH, Downey M, et al. Epidural and intravenous fentanyl infusions are clinically equivalent after knee surgery. Anesth Analg 1990; 70: 72-5
68. Sarantopoulos C, Fassoulaki A. Systemic opioids enhance the spread of sensory analgesia produced by intrathecal lidocaine. Anesth Analg 1994; 79: 94-7
69. Eisenach JC, De Kock M, Klimscha W. Alpha2-adrenergic agonists for regional anesthesia: a clinical review of clonidine (1984-1995). Anesthesiology 1996; 85: 655-74
70. Rockemann MG, Seeling W, Duschek S, et al. Epidural bolus clonidine/morphine versus epidural patient-controlled bupivacaine/sufentanil: quality of postoperative analgesia and cost-identification analysis. Anesth Analg 1997; 85: 864-9
71. Scherer R, Schmutzler M, Giebler R, et al. Complications related to thoracic epidural analgesia: a prospective study in 1071 patients. Acta Anaesthesiol Scand 1993; 35: 370-3
72. Tanaka K, Watanabe R, Harada T, et al. Extensive application ot epidural anesthesia and analgesia in a university hospital: incidence of complications related to technique. Reg Anesth 1993; 18: 34-8
73. Kopacz DJ, Slover RB. Accidental epidural cephazolin injection: safeguards for patient-controlled analgesia. Anesthesiology 1990; 72: 944-7
74. Prince GD, Shetty GR, Miles M. Safety and efficacy of a low volume extradural test dose of hupivacame in labour. Br J Anaesth 1989; 62: 503-8
75. Crosby ET, Halpern S. Failure of lidocaine lest to identify subdural placement of an epidural catheter. Can J Anaesth 1989; 36: 445-7
76. Collier CB, Gatt SP. A new epidural catheter. Closer eyes for safety? Anaesthesia 1993; 48: 803-6
77. Colonna-Romano P, Liugaraju N, Braitman LE. Epidural test dose: lidocaine 100mg, not chloroprocaine, is a symptomatic marker of iv injection in labouring parturients. Can J Anaesth 1993; 40: 714-7
78. Roetman KJ, Eisenach JC. Evaluation of lidocaine as an intravenous test dose for epidural anesthesia [abstract]. Anesthesiology 1988; 69: A669
79. Moore DC, Batra MS. The components of an effective test dose prior to epidural block. Anesthesiology 1981; 55: 693-6
80. Guinard JP, Mulroy MF, Carpenter RL, et al. Test doses: optimal epinephrine content with and without acute beta-adrenergic blockade. Anesthesiology 1990; 73: 386-92
81. Leighton BL, Norris MC, Sosis M, et al. Limitations of epinephrine as a marker of intravascular injection in laboring women. Anesthesiologv 1987; 66: 688-91
82. Hood DD, Dewan DM, James III FM. Maternal and fetal effects of epinephrine in gravide ewes. Anesthesiology 1986; 64: 610-3
83. Guinard JP, Mulroy MF, Carpenter RL. Aging reduces the reliability of epidural epinephrine test doses. Reg Anesth 1995; 20: 193-8
84. Liu S, Carpenter RL. Hemodynamic responses to intravascular injection of epinephrine containing test doses in adults during general anesthesia. Anesthesiology 1996; 84: 81-7
85. Liu S. Hemodynamic responses to an epinephrine lest dose in adults during epidural or combined epidural-general anesthesia. Anesth Analg 1996; 83: 97-101
86. Sawehuk CWT, Ong B, Unruh HW, et al. Thoracic versus lumbar epidural fentanyl for post thoracotomy pain. Ann Thorac Surg 1993; 55: 1472-6
87. D'Angelo R, Berkebile BL, Gerancher JC. Prospective examination of epidural catheter insertion. Anesthesiology 1996; 84: 88-93
88. Hamilton CL, Riley ET, Cohen SE. Changes in the position of epidural catheters associated with patient movement. Anesthesiology 1997; 86: 778-84
89. Darchy B, Forceville X, Bavoux E, et al. Clinical and bacteriologic survey of epidural analgesia in patients in the intensive care unit. Anesthesiology 1996; 85: 988-98
90. Jakobsen KB, Christensen MK, Carlsson PS. Extradural anaesthesia for repeated surgical treatment in the presence of infection. Br J Anaesth 1995; 75: 536-40
91. Sato S, Sakuragi T, Dan K. Human skin flora as a potential source of epidural abscess. Anesthesiology 1996; 85: 1276-82
92. Rainov NG, Heidecke V, Burkert WL. Spinal epidural hematoma: report of a case and review of the literature. Neurosurg Rev 1995; 18: 53-60
93. Schwander D, Bachmann F. Heparin and spinal or epidural anesthesia: decision analysis. Ann Fr Anesth Réanim 1991; 10: 284-96
94. Vandermeulen EP, Van Aken H, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg 1994; 79: 1165-77