Pain Control with Epidural Injection of Morphine

Chayen, M. S.; Rudick, Valery; Borvine, A; Bridenbaugh, L. Donald

doi:10.1097/00132586-198108000-00056

Cited by 6 publications

(10 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Following a consistent positive response to epidural morphine (50% or greater reduction in VPAS) on each of the 3 days, the patients were considered candidates for implantation of the INFUSAID model #400 pump for continuous infusion of SAN. Three patients did not 10 -…”

Section: San Trialmentioning

confidence: 99%

Continuous infusion of spinally administered narcotics for the relief of pain due to malignant disorders

Krames

Gershow²,

Glassberg³

et al. 1985

Cancer

161

View full text Add to dashboard Cite

The INFUSAID model #400 totally implantable drug delivery system was implanted in 17 patients for the continuous infusion of spinally administered preservative-free morphine sulfate. Sixteen patients had pain of malignant origin, and one patient had pain secondary to meningomyelocele. Over time, there was a consistent mean improvement in analgesia scores ranging from 50% to 70% of the control levels for 16 of the patients with cancer-related pain. This form of pain therapy was not successful in treating the benign pain of the patient with meningomyelocele. Overall, the patients with cancer were pleased with their pain therapy, experienced few complications, and reported improved quality of life. Continuous infusion of spinally administered narcotics using a totally implantable drug delivery system such as the INFUSAID model #400 is a safe, complication-free procedure for the control of cancerrelated pain.Cancer 56:696-702, 1985.MALL DOSES OF spinally administered narcotics S (SAN), when injected peridurally or intrathecally, produce profound analgesia. This analgesic effect of exogenous SAN results from opiate blocking of enkephalinergic receptors in the substantia gelatinosa of the spinal cord. The presence of opiate receptors on cell membranes in the brain and spinal cord of vertebrate animals has been studied by severalOther investigators have described endogenous opioid-like peptides which also act at these These peptides-endorphins and enkephalins alike-modulate the reception of nociceptive information. Metenkephalin, an endogenous peptide, is released by axons of the descending modulation pathways in the substantia gelatinosa of the spinal cord in response to afferant painful inputs to rostra1 brain centers. This opioid-like peptide binds to opiate receptors of postsynaptic interneurons and prevents the reception of "substance P," an excitatory protein necessary for the transmission of noxious information released by adelta and c-fiber afferants. By substituting long-acting SAN for metenkephalin, (which has a halflife in the millisecond range) prolonged and profound

show abstract

Section: San Trialmentioning

confidence: 99%

Continuous infusion of spinally administered narcotics for the relief of pain due to malignant disorders

Krames

Gershow²,

Glassberg³

et al. 1985

Cancer

161

View full text Add to dashboard Cite

show abstract

“…Systemic techniques are always applicable and several drugs may be used, such as NSAIDs and opioids, which remain as the support for treating severe pain 4,10 . However, simple or continuous epidural 13,14,16,22 , intercostal block 23 or intrapleural block [24][25][26][27][28] are the best known techniques to treat post-thoracotomy pain. Epidural analgesia may be induced by the single administration of local anesthetics, opioids, including agonists-antagonists and adrenergic agonists, and by the association of local anesthetics and opioids 9, 16,17 .…”

Section: Resultsmentioning

confidence: 99%

“…As técnicas sistêmicas são sempre aplicáveis, podendo ser usadas várias drogas, como antiinflamatórios não-esteroidais e opióides, que permanecem como esteio do tratamento da dor de forte intensidade 4,10 . Porém, as técnicas mais conhecidas para o tratamento da dor após a cirurgia de tórax são a peridural simples ou contínua 13,14,16,22 , bloqueio intercostal 23 ou bloqueio intrapleural [24][25][26][27][28] . A analgesia peridural pode ser feita com a administração isolada de anestésico local, opióide, incluindo os agonistas-antagonistas, agonistas adrenérgicos e por associação entre anestésicos locais e opióides 9, 16,17 .…”

Section: Tabela I -Dados Demográficosunclassified

“…A analgesia pós-cirurgia de tórax tem sido feita com técnicas sistê-micas ou regionais, administrando antiinflamatórios não hormonais, anestésicos locais, opióides e outros 9 . Estudos demonstram o efeito analgésico prolongado da morfina por via peridural, com baixos índices de efeitos colaterais em relação ao estado de vigília, à função neuromuscular e ao sistema nervoso simpático [10][11][12][13][14] . Contudo, evidên-cias obtidas de estudos para analgesia são conflitantes em afirmar maior benefício da analgesia com morfina por via peridural em relação à venosa [15][16][17][18] , sendo também questionável a associação de opióides com outros medicamentos para otimizar a qualidade analgésica com menores efeitos colaterais 9,18 .…”

Section: Introductionunclassified

“…Post-thoracotomy analgesia has been induced by systemic or regional techniques, by administering NSAIDs, local anesthetics, opioids and others 9 . Studies have shown a prolonged epidural morphine analgesic effect, with low incidence of side-effects in terms of alertness, neuromuscular function and sympathetic nervous system [10][11][12][13][14] . However, analgesic evidences are conflicting in determining a better analgesic effect with epidural as compared to intravenous morphine [15][16][17][18] , being also questionable the association of opioids and other drugs to optimize analgesia with less side-effects 9,18 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Analgesia pós-toracotomia com associação de morfina por via peridural e venosa

Fonseca¹,

Mandim²,

Amorim³

2002

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

show abstract

Postoperative analgesia in dogs receiving epidural morphine plus medetomidine

Pacharinsak

Greene

Keegan

et al. 2003

Vet Pharm & Therapeutics

View full text Add to dashboard Cite

This investigation was carried out to compare the postoperative analgesia and plasma morphine concentrations in dogs given epidural morphine or epidural morphine combined with medetomidine prior to surgery. Twelve dogs (seven males and five females) with ruptured cranial cruciate ligaments presented to the Washington State University Veterinary Teaching Hospital. Six dogs received an epidural injection of morphine (0.1 mg/kg) and six dogs received epidural morphine (0.1 mg/kg) combined with medetomidine (0.005 mg/kg). Numeric rating scale (NRS) pain scores and cumulative pain scores (CPS) were assigned to 10-min segments of video. Video segments, heart rates and respiratory rates were recorded prior to premedication and at 4, 8, 12, 18 and 24 h after epidural injection. Blood was sampled from the cephalic vein at each of these times and during anesthesia at 0.5, 1, 2 and 3 h after epidural injection. Data were analyzed using either Friedman's test or one-way anova for repeated measures. In the morphine group, significant increases compared with premedication values were detected at 4, 8 and 12 h after epidural injection for NRS and at 4 and 12 h after epidural injection for CPS. In the morphine plus medetomidine group, NRS was significantly higher at 4 and 8 h whereas there were no differences from baseline values for CPS. Plasma morphine concentrations were not significantly different between treatment groups, but were significantly increased compared with preinjection values at 0.5, 1, 12, 18, and 24 h in the morphine plus medetomidine group. Epidurally administered morphine combined with medetomidine was associated with only minor benefits based on subjective pain scoring when compared with morphine alone in these dogs undergoing repair of a ruptured cranial cruciate ligament.

show abstract

Pain Control with Epidural Injection of Morphine

Cited by 6 publications

References 0 publications

Continuous infusion of spinally administered narcotics for the relief of pain due to malignant disorders

Continuous infusion of spinally administered narcotics for the relief of pain due to malignant disorders

Analgesia pós-toracotomia com associação de morfina por via peridural e venosa

Postoperative analgesia in dogs receiving epidural morphine plus medetomidine

Contact Info

Product

Resources

About