The Options for Neuraxial Drug Administration

Hermanns, Henning; Bos, E.M.E.; Zuylen, Mark L. van; Hollmann, Markus W.; Stevens, Markus F.

doi:10.1007/s40263-022-00936-y

Cited by 12 publications

(7 citation statements)

References 230 publications

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“…PONV is considered a result of vascular uptake 30 ; however, pruritus and delayed respiratory depression are due to the rostral spread of morphine through the cerebrospinal fluid. [30][31][32] Based on the results of our study, the lowered dose of ITM to 300 μg might offer adequate postoperative analgesia with the added benefit of decreased PONV in pure laparoscopic living donor hepatectomy.…”

Section: Discussionmentioning

confidence: 88%

Comparison of two doses of intrathecal morphine in laparoscopic donor hepatectomy: A randomized double‐blinded non‐inferiority trial

Lee

Kang

Choi

et al. 2023

Clinical Transplantation

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BackgroundIntrathecal morphine (ITM) injection is an effective postoperative analgesic strategy in open or laparoscopic donor hepatectomy; however, the optimal dose has not been determined. In this trial, we compared the post‐operative analgesic effects of two doses (300 vs. 400 μg) of ITM injections.MethodsIn this prospective randomized non‐inferiority trial, 56 donors were divided into either the 300 μg or 400 μg ITM group (n = 28, each). The primary outcome was the resting pain score at 24 h postoperatively. Pain scores, cumulative opioid consumption, and side effects (postoperative nausea and vomiting [PONV]) were compared up to 48 h postoperatively.ResultsFifty‐five donors participated in the entire study. The mean resting pain scores at 24 h after surgery were 1.7 ± 1.6 and 1.7 ± 1.1 in the ITM 300 and ITM 400 groups, respectively (mean difference, 0 [95% CI, −.8 to .7], p = .978). The upper limit of the 95% CI was lower than the prespecified non‐inferiority margin (δ = 1), indicating that non‐inferiority had been established. The incidence of PONV was lower in the ITM 300 group than in the ITM 400 group at 18 (p = .035) and 24 h postoperatively (p = .015). There were no significant differences in the resting and coughing pain scores and cumulative opioid consumption at any time point.ConclusionFor laparoscopic donor hepatectomy, preoperative ITM 300 μg exhibited non‐inferior postoperative analgesic effects compared to ITM 400 μg, with a lower incidence of PONV.

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Section: Discussionmentioning

confidence: 88%

Comparison of two doses of intrathecal morphine in laparoscopic donor hepatectomy: A randomized double‐blinded non‐inferiority trial

Lee

Kang

Choi

et al. 2023

Clinical Transplantation

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“…This technique finds wide application in surgeries involving the abdomen, pelvis, lower extremities, and labor analgesia. [ 73 , 74 ] Similarly, peripheral nerve blockades (PNB) inject local anesthetics and additives to the vicinity of peripheral nerves for perioperative anesthesia and analgesia. [ 75 , 76 ] Conversely, LA selectively numbs small areas following topical administration or direct infiltration of local anesthetics, which is commonly applied for cutaneous, dental and head and neck procedures.…”

Section: Modern Anesthesia and Related Toxicitymentioning

confidence: 99%

Nanotherapeutics for Alleviating Anesthesia‐Associated Complications

Lu,

Wei,

Shi

et al. 2024

Advanced Science

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Current management of anesthesia‐associated complications falls short in terms of both efficacy and safety. Nanomaterials with versatile properties and unique nano‐bio interactions hold substantial promise as therapeutics for addressing these complications. This review conducts a thorough examination of the existing nanotherapeutics and highlights the strategies for developing prospective nanomedicines to mitigate anesthetics‐related toxicity. Initially, general, regional, and local anesthesia along with the commonly used anesthetics and related prevalent side effects are introduced. Furthermore, employing nanotechnology to prevent and alleviate the complications of anesthetics is systematically demonstrated from three aspects, that is, developing 1) safe nano‐formulization for anesthetics; 2) nano‐antidotes to sequester overdosed anesthetics and alter their pharmacokinetics; 3) nanomedicines with pharmacodynamic activities to treat anesthetics toxicity. Finally, the prospects and challenges facing the clinical translation of nanotherapeutics for anesthesia‐related complications are discussed. This work provides a comprehensive roadmap for developing effective nanotherapeutics to prevent and mitigate anesthesia‐associated toxicity, which can potentially revolutionize the management of anesthesia complications.

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“…In the last few decades, several non-anesthetic applications for epidural procedures have emerged. Epidural catheter infusion techniques of analgesics are being used increasingly for pain control at the end of life in both children and adults, including those with cancer-related pain [91]. In addition to opioids, which are commonly added to epidurally administered local anesthetics, a large number of other pharmacologic agents have been used.…”

Section: Adjuvants For Epidural Administrationmentioning

confidence: 99%

Physiology and Pharmacology of Epidurally Administered Drugs

Brusich¹,

Valenčić²,

Polonijo³

2023

Epidural Administration - New Perspectives and Uses

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In the last few decades, epidural administration of various drugs has gained popularity and widespread clinical acceptance. Epidural administration of local anesthetics and opioids has been considered “state of the art” in acute pain management (thoracic and major abdominal surgery, labor). Its advantage is that it yields profound, long-lasting, dose-dependent analgesia, leaving other sensory and motor functions intact. It facilitates early patient mobilization and ambulation and therefore reduces the risk of postoperative thromboembolism and respiratory complications. The increment in the elderly population caused an increase in musculoskeletal and spine diseases and thus, epidural steroid injections have become highly effective for chronic pain treatment. There are many factors that have an impact on drug physiology and pharmacology in the epidural space and, therefore, can modify epidural anesthesia or the expected effect of another medication. This chapter provides insight into this complex and comprehensive topic to demonstrate a predictable pattern that can provide a safe and accurate guide to clinical practice.

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The Options for Neuraxial Drug Administration

Cited by 12 publications

References 230 publications

Comparison of two doses of intrathecal morphine in laparoscopic donor hepatectomy: A randomized double‐blinded non‐inferiority trial

Comparison of two doses of intrathecal morphine in laparoscopic donor hepatectomy: A randomized double‐blinded non‐inferiority trial

Nanotherapeutics for Alleviating Anesthesia‐Associated Complications

Physiology and Pharmacology of Epidurally Administered Drugs

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