What is regional opioid analgesia?

Castro, J. De; Meynadier, J.; Zenz, M.

doi:10.1007/978-94-009-2321-8_20

Cited by 2 publications

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“…Morphine slowly migrates rostrally to the brainstem and may induce late-onset respiratory depression [13]. Morphine-naive patients may develop respiratory depression within 12-24 h (1:1200 incidence); however, respiratory depression occurs rarely in patients using morphine chronically [14].…”

Section: Physical and Chemical Properties Of Spinal Opioidsmentioning

confidence: 99%

Long-Term Spinal Opioid Therapy in Terminally Ill Cancer Pain Patients

1997

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In terminally ill cancer patients with refractory pain, long-term spinal opioid therapy may provide a profound analgesia with minimal side effects. The reversibility of the technique and its efficacy throughout the body and for different types of pain are important advantages. For epidural administration, it is preferable to use lipid soluble opioids (sufentanil). For intrathecal administration, morphine is the best choice. The advantages of intrathecal administration over epidural administration are the need for lower doses because of a more direct administration at the receptor site, the easy positioning of the catheter, and less risk for migration of the catheter. In severe refractory pain which does not respond to spinal opioids, the use of nonopioids (e.g., a local anesthetic or an alpha-2 adrenoreceptor agonist) as coanalgesics may be recommended for improving pain relief. Long-term spinal opioid therapy at home has been made possible by technical and organizational development. In home care, only one physician should be the manager for the patient. Coordination should be optimized among patient, family, general practitioner, oncologist, anesthesiologist, home nurse, technician, and pharmacist.

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Section: Physical and Chemical Properties Of Spinal Opioidsmentioning

confidence: 99%

Long-Term Spinal Opioid Therapy in Terminally Ill Cancer Pain Patients

1997

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“…Opioids have been shown to cross many surface barriers, including the placenta, eventually reaching fetal circulation[5,6]. Despite the extensive use of opioids by pregnant women, however, few studies have addressed the safety of fetal exposure during the first trimester of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcome following opioid exposure: A cohort study

et al. 2019

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Introduction Opioids constitute a cornerstone of pain relief treatment. However, opioid safety during pregnancy has not been well established. Recent studies reported an association between in utero opioid exposure and spina bifida. Methods In order to further evaluate the association of opioids exposure during pregnancy with adverse pregnancy outcomes, we conducted a large historical cohort by linking four databases: medications dispensations, births, pregnancy terminations for medical reasons and infant hospitalizations during the years of 1999–2009. Confounders that were controlled for included maternal age, ethnicity, maternal diabetes, smoking status, parity, obesity, year and folic acid intake. A secondary analysis for total major malformations and for spina bifida was performed using propensity score matching for first trimester exposure. Results Of the 101,586 women included in the study, 3003 were dispensed opioids during the first trimester. Intrauterine exposure to opioids was not associated with overall major malformations (adjusted odds ratio (aOR) 0.97, 95% CI 0.83–1.13), cardiovascular malformations (aOR = 0.89, 95% CI 0.70–1.13) other malformations by systems or spina bifida in particular. However, the risk for spina bifida among newborns and abortuses who were exposed to codeine was four times higher than that of the unexposed (aOR = 4.42, 95% CI 1.60–12.23). This association remained significant in a secondary analysis using propensity score matching. Third trimester exposure to opioids was not associated with low birth weight (aOR = 1.08, 95% CI 0.77–1.52), perinatal death (aOR = 1.38, 95% CI 0.64–2.99) and other adverse pregnancy outcomes. Conclusions These findings suggest that opioids exposure (as a homogenous group) is not a significant risk factor for overall major malformations. Exposure to codeine during the first trimester was found to be associated with increased risk of spina bifida. However, this finding was based on a small number of cases and need to be verified in future work.

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What is regional opioid analgesia?

Cited by 2 publications

References 0 publications

Long-Term Spinal Opioid Therapy in Terminally Ill Cancer Pain Patients

Long-Term Spinal Opioid Therapy in Terminally Ill Cancer Pain Patients

Pregnancy outcome following opioid exposure: A cohort study

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