The use of intrathecal morphine could potentially be useful in controlling the pain experienced by spinal surgery patients postoperatively; however, there have been reported side effects, which include pruritis, urinary retention, nausea and vomiting, and the most serious of all, respiratory depression.
What are the possible side effects of intrathecal morphine?
Results: Most side effects of intrathecal morphine therapy are dose dependent and mediated by opioid receptors. Common ones include nausea, vomiting, pruritus, urinary retention, constipation, sexual dysfunction, and edema. Less common ones include respiratory depression, and hyperalgesia.
What are the indications for intrathecal therapy in chronic pain management?
Chronic or persistent non-malignant pain may be managed with neuraxial interventions. Clinical indications for intrathecal therapy in CNMP include neuropathy (post-herpetic neuralgia and peripheral neuropathy), mixed neuropathic–nociceptive pain, radicular pain from failed back syndrome and complex regional pain syndrome (CRPS).
What is intrathecal analgesia?
Intrathecal analgesia is the administration of analgesic drugs (as listed above) directly into the CSF in the intrathecal space.6The intrathecal space may also be referred to as the subarachnoid space.
What are the side effects of opioids?
Opioid Side Effects Opioids are best known for their pain-relieving and euphoric effects, but the powerful drugs have a host of side effects. Opioids frequently cause nausea, vomiting, constipation and severe itching. Long-term use can lead to dependence, addiction and numerous physical complications, including overdose and death.
What are common side effects of giving intrathecal or epidural opioids?
The four classic side effects are pruritus, nausea and vomiting, urinary retention, and respiratory depression. Numerous other side effects have also been described. Most side effects are dose-dependent and may be more common if the opioid is administered intrathecally.
What is the most common serious complication associated with opioid intrathecal and epidural administration?
The most common complications occurring with epidural analgesia are maternal hypotension and postdural puncture headache. Retrospective studies have demonstrated an association between epidural analgesia and increases in duration of labor, instrumental vaginal delivery and cesarean section for labor.
What are common effects or side effects of giving an anesthetic via intrathecal or epidural routes?
Respiratory depression is the most common side effect of administration of opioid intrathecal, epidural, or intrapleural analgesia. Other common side effects of administration include sedation, pruritis, nausea and vomiting, urinary retention / relaxation of bladder muscle, epidural abscess or hematoma.
Which of the following are complications that can occur from epidural or intrathecal analgesia?
In general, complications from continuous epidural analgesia can be categorized as medication related or catheter related. Medication-related complications include nausea, vomiting, pruritus, motor block, hypotension, and respiratory depression.
What is a possible side effect of an epidural?
Potential side effects of an epidural may include headache, soreness, urination problems, and a decrease in blood pressure. While long-term complications are extremely rare, they may result in permanent nerve damage and persistent numbness and tingling.
What is the difference between epidural and intrathecal?
Intrathecal administration is delivered directly into the CSF and into the superifical spinal cord; epidural administration diffuses through the dura into the CSF, and thus has a slower onset of action.
What is the most common complication of spinal anesthesia?
The most common are postdural puncture headache and hypotension. Hypotension after spinal anesthesia is a physiological consequence of sympathetic blockade.
Does intrathecal morphine cause hypotension?
A single dose of intrathecal morphine can lead to orthostatic hypotension in patients with intravascular hypovolemia or impaired myocardial function on sympatholytic drugs. Intrathecal morphine can lead to bradycardia that may potentiate hypotension further.
Why does an epidural cause hypotension?
A frequent unwanted side effect of epidural block is hypotension due to the epidurally injected LA blocking the sympathetic nerves and thus the patient's response to hypotension, which is usually due to hypovolemia and/or an unopposed parasympathetic (via the vagus nerve) nervous system.
Can a spinal block cause permanent damage?
Permanent damage to nerves is very rare. The risk of longer-lasting problems after a spinal or epidural injection is: Permanent harm occurs between 1 in 23,500 and 1 in 50,500 spinal or epidural injections.
What are the disadvantages of spinal anesthesia?
What are the risks of having a spinal anaesthetic?Failure of the spinal.Pain during the injection.Low blood pressure.Headaches.Itching.Difficultly passing urine.Backache.
Which of the following are contraindications to epidural analgesia?
Contraindications to the use of a neuraxial (i.e., epidural or subarachnoid) technique include patient refusal, active maternal hemorrhage, septicemia, infection at or near the site of needle insertion and clinical signs of coagulopathy (Table 2).
QUESTIONS
Before continuing, try to answer the following questions. The answers can be found at the end of the article, together with an explanation. Please answer True or False:
INTRODUCTION
Spinal anaesthesia is when local anaesthetic is injected intrathecally (i.e. into the cerebrospinal fluid in the subarachnoid space) to establish a spinal block and facilitate a surgical procedure. Equally, opioids can be injected intrathecally either as single agents (e.g.
Historical Background
During the mid to late 19th century, as the world of anaesthesia was evolving, interest developed in the spinal cord as a potential analgesic target. James Leonard Corning and August Bier led the way in neuraxial blockade with the use of cocaine, while Bier successfully performed surgery under neuraxial block in Kiel in 1898 1.
PHARMACOLOGY OF INTRATHECAL OPIOIDS
The fundamental effect of an opioid binding to its receptor in the spinal cord is to decrease, or turn off, a passing nociceptive signal. While they also modulate the pain pathway in the midbrain by influencing the descending pathways, it is this signal blocking aspect that is integral to their effect.
Pharmacodynamics
A thorough understanding of the pharmacodynamic properties of the various opioids, and the differences between them, informs us of their efficacy and most troublesome adverse effects. The most clinically relevant property of the drug is the degree of lipophilicity 2.
CLINICAL USES OF INTRATHECAL OPIOIDS
There are a number of indications for intrathecal opioids. We will discuss its use during the peri-operative period for acute pain management and also briefly its use in the treatment of chronic cancer pain. Of note, only preservative free opioids should be used for injection into the CSF.
COMPLICATIONS OF INTRATHECAL OPIOIDS
As with all routes of administration, opioids exert beneficial analgesic effects but at the cost of potentially serious side effects. Respiratory depression and, more specifically with ITM, delayed respiratory depression are the most feared complication of intrathecal opioids.
What causes morphine to ascend?
14.15 The underlying cause of ascension of morphine is bulk flow of eerebrospinal fluid. Cerebrospinal fluid ascends in a cephalad direction from the lumbar region, reaching the cisterna magna by one or two hours and the fourth and lateral ventricles by three to six hours.
Is intrath-ecal pain management nonnociceptive?
However, a wide variety of clinically relevant non-nociceptive side effects may occur.
Abstract
The purpose of this article is to review the literature on the side effects of intrathecal and epidural opioids. English-language articles were identified through a MEDLINE search and through review of the bibliographies of identified articles.
Résumé
Ce travail constitue un survol de la littérature portant sur les effets secondaires des morphiniques sous-arachnoïdiens et épiduraux. Les articles en langue anglaise ont été identifiés grâce à une recherche sur Medline et une revue des bibliographies des articles trouvés de cette façon.
Is PONV a side effect of anaesthesia?
Moreover, although PONV has been reported less frequently with regional than general anaesthesia [ 3, 4 ], it remains a problem especially in outpatient procedures, where regional anaesthesia is increasingly used, and occurrence of PONV may delay discharge or cause unanticipated hospital admission [ 5 ].
Is spinal anaesthesia a small dose?
Spinal anaesthesia is extensively and routinely used, while adding small dose opioids to spinal solutions to implement spinal block, and prolong postoperative analgesia has become a common and popular practice among anaesthesiologists. Morphine is undoubtedly the opioid agent most frequently used for this purposes and the literature supports the evidence of its efficacy in reducing postoperative pain, differently from other lipophilic opioids, like fentanyl and sufentanil [ 7 ]. However, there is not general consensus about the risk–benefit ratio of various dosing regimens proposed in clinical studies, and the incidence of side-effects as well as its relation to the dosing regimen used is still controversial. Moreover, clinical studies usually evaluate efficacy and safety in patients undergoing surgery; but several procedure-related confounding factors can potentially interfere with the evaluation of nausea, vomiting and other minor opioid-related side-effects. In this prospective, randomized, double-blinded investigation we evaluated the incidence of most frequently reported opioid-related side-effects in patients not undergoing surgery, and receiving the intrathecal administration of different doses of morphine; and results showed that, when used in doses ranging from 0.015 to 0.25 mg, early side-effects like itching, nausea and vomiting were present also at very low doses (0.015–0.03 mg), while increasing the dose did not result in a correlated increase in the incidence of side-effects. On the other hand, the incidence of nausea surprisingly reduced with increasing the dose of morphine from 0.03 to 0.25 mg.
What are the side effects of taking opiates?
Prescription Opioid Side Effects. The most common opioid side effects are constipation and nausea. These effects can be challenging to manage; this is especially true for constipation, which may be severe enough to require discontinuation of the opioids. Other common side effects can also include: sedation. dizziness.
Why are opioids controversial?
One of the primary reasons is physical tolerance and the well-known psychological addiction that often occurs with these medications .
Why should opioids be taken exactly as prescribed?
Patients must understand that opioid medications affect many organs while influencing a large number of body functions. More importantly, opioids should be taken exactly as prescribed to avoid severe effects, and to alter the dose in any way can be dangerous.
How many people abuse opioids?
The National Institute on Drug Abuse (NIDA), reports that between 26.4 million and 36 million people around the world abuse opioid drugs, including prescription pain relievers and heroin.
Is it dangerous to take opioids?
Opioids are potent narcotics and, in some cases, even dangerous. Abuse, whether prescription painkillers or heroin, can have a severe impact on your physical and emotional health. Also, abusing painkillers, sharing needles, or injecting crushed pills poses dangers.
Can opioids cause allergic reactions?
An allergic reaction is also possible with opioids, and signs can include: Hives or swelling of the lips, face, tongue, or throat. Any of these opioid side effects should prompt an immediate visit to the emergency room. Opioids are potent narcotics and, in some cases, even dangerous.
Can you take opioids with alcohol?
Taking opioids with alcohol can cause a dangerous reaction, including slowed breathing and overdose. Drowsiness can be magnified by patients who receive opioids with other narcotics, allergy medication, tranquilizers, and sleeping pills.
What are the effects of opioids?
The drugs can also produce a range of unwanted effects, ranging from nausea and constipation to extreme sedation, breathing problems and even death.
What are the short term effects of opioids?
Short-Term Effects of Opioids. Morphine, oxycodone, hydrocodone and other opioids can cause a wide range of short-term effects. Nausea, vomiting, dizziness and sedation are among the most common reactions to the drugs. Side effects can develop even when the drugs are used as directed. Other short-term effects of opioids include: ...
How long does it take for opioid withdrawal symptoms to go away?
Symptoms typically peak within two to three days and resolve within a week. Withdrawal from longer-acting opioids, such as methadone or OxyContin, may not begin for 24 to 72 hours and will peak within a week to 10 days. Symptoms can last up to three weeks. A medical detox can ease the pain of opioid withdrawal.
Why do opioids stop breathing?
Because opioids depress the central nervous system, high doses can dangerously slow or stop your breathing. This can cut off blood flow to your brain and kill you. Pauses in breathing are particularly common at night but can occur at any time.
What are the side effects of opium?
Opioids frequently cause nausea, vomiting, constipation and severe itching. Long-term use can lead to dependence, addiction and numerous physical complications, including overdose and death.
How many people died from opioid overdose in 2016?
As prescriptions for opioid painkillers have soared over the last two decades, so have rates of opioid addiction. In 2016, more than 42,000 people died from an opioid overdose, and an estimated 2.1 million Americans were addicted to opioids.
What happens when you stop taking opioids?
When you’re opioid dependent, you’ll have a high tolerance and need increasingly larger amounts the drug to achieve the desired effects. You’ll also become ill when you stop taking the drug or reduce your normal dose.