Postoperative pain can be effectively managed with epidurally administered opioids or local anesthetics. This article briefly reviews spinal cord anatomy. Pharmacokinetic and pharmacodynamic properties of epidurally administered opioids and local anesthetics are outlined. The pharmacist's participation in a pharmaceutical care plan for the acute postoperative pain patient is also discussed.
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References
1.
Agency for Health Care Policy and Research: Acute pain management: Operative or medical procedures or trauma, part 1. Clin Pharm11:309–331, 1992.
2.
MarksRMSacharEJ: Undertreatment of medical inpatients with narcotic analgesics. Ann Intern Med78:173–181, 1973.
3.
SriwatanakulKWeisOFAllozaJL: Analysis of narcotic usage in the treatment of postoperative pain. JAMA250:926–929, 1983.
4.
DonovanMDillonPMcGuireL: Incidence and characteristics of pain in a sample of medical-surgical inpatients. Pain30:69–78, 1987.
5.
OdenR: Acute postoperative pain: Incidence, severity, and the etiology of inadequate treatment. Anesthesiol Clin North Am7:1–15, 1989.
ShaferALDonnellyAJ: Management of postoperative pain by continuous epidural infusion of analgesics. Clin Pharm10:745–764, 1991.
8.
LitrellRA: Epidural analgesia. Am J Hosp Pharm48:2460–2474, 1991.
9.
CousinsMJMatherLE: Intrathecal and epidural administration of opioids. Anesthesiology61:276–310, 1984.
10.
ScottDB: Epidural blockade, in RogersMCTinkerJHCovinoBG: Principles and Practice of Anesthesiology, Vol 2. St. Louis, MO, Mosby Year Book, 1992, pp 1239–1310.
11.
LubenowTR: Epidural Analgesia: Considerations and Delivery Methods, in SinatraRSHordAHGinsbergB (eds): Acute Pain: Mechanisms and Management. St. Louis, MO, Mosby Year Book, 1992, pp 233–242.
12.
SinatraRS: Pharmacokinetics and pharmacodynamics of spinal opioids, in SinatraRSHordAHGinsbergB (eds): Acute Pain: Mechanisms and Management. St. Louis, MO, Mosby Year Book, 1992, pp 102–111.
13.
LubenowTRMcCarthyRJIvankovichAD: Management of acute postoperative pain, in BarashPGCullenBFStoeltingRK (eds): Clinical Anesthesia, 2nd ed. Philadelphia, PA, 1992, pp 1547–1578.
14.
GrichnikKGinsbergB: Epidural analgesia for patients recovering from surgery, in SinatraRSHordAHGinsbergB (eds): Acute Pain Mechanisms and Management. St. Louis, MO, 1992, pp 243–252.
15.
RajPPKnarrDCVigdorthE: Comparison of continous epidural infusion of a local anesthetic and administration of systemic narcotics in the management of pain after total knee replacement surgery. Anesth Analg66:401–406, 1987.
16.
WellerRRosenblumMConardP: Comparison of epidural and patient-controlled intravenous morphine following joint replacement surgery. Can J Anaesth38:582–526, 1991.
17.
GrantRPDolmanJFHarperJA: Patient-controlled lumbar epidural fentanyl compared with patient-controlled intravenous fentanyl for post-thoracotomy pain. Can J Anaesth39:214–219, 1992.
18.
El-BazNMFaberLPJensikRJ: Continous epidural infusion of morphine for treatment of pain after thoracic surgery: A new technique. Anesth Analg63:757–764, 1984.
19.
CousinsMJWrightCJ: Graft muscle skin blood flow after epidural block in vascular surgical procedures. Surg Gynecol Obstet, 33:59–64, 1971.
20.
TumanKJMcCarthyRJMarchRJ: Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg73:696–704, 1991.
21.
YeagerMPGlassDDNeffRK: Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology66:729–736, 1987.
22.
GlassPEstokPGinsbergLB: Use of patient-controlled analgesia to compare the efficacy of epidural to intravenous fentanyl administration. Anesth Analg74:345–351. 1992.
23.
LoperKAReadyBLDowneyM: Epidural and intravenous fentanyl infusions are clinically equivalent after knee surgery. Anesth Analg70:72–75, 1990.
24.
PanosLSandlerANStringerDG: Epidural vs intravenous fentanyl infusions in post-thoracotomy patient: Analgesic and pharmacokinetic effects. Anesthesiology73: A831, 1990.
25.
EllisDJMillerWLReisnerLS: Comparison of epidural and intravenous fentanyl infusions after cesarean section. Anesthesiology72:981–986, 1990.
26.
MiguelRBarlowIMorrellM: A double-blind comparison of epidural and intravenous sufentanil in the management of pain following exploratory laporatomy. Anesthesiology77:A823, 1992.
27.
CamuFDebucquoyF: Alfentanil infusion for postoperative pain: A comparison of epidural and intravenous routes. Anesthesiology75:171–178, 1991.
28.
ChungJHHarrisSN: Common side effects associated with spinal opioids and their treatment, in SinatraRSHordAHGinsbergB (eds): Acute Pain: Mechanisms and Management. St. Louis, MO, Mosby Year Book, 1992, pp 279–292.
29.
SandsP: The role of the pharmacist in acute pain management, in SinatraRSHordAHGinsbergB (eds): Acute Pain: Mechanisms and Management. St. Louis, MO, Mosby Year Book, 1992, pp 596–600.
30.
DuPenSLRamseyDChinS: Chronic epidural morphine and preservative-induced injury. Anesthesiology67:987–988.
31.
AllenLVStilesMLTuYH: Stability of fentanyl citrate in 0.9% sodium choride solution in portable infusion pumps. Am J Hosp Pharm47:1572–1574, 1990.
32.
TuYHStilesMLAllenLV: Stability of fentanyl citrate and bupivacaine hydrochloride in portable pump reservoirs. Am J Hosp Pharm47:2037–2040, 1990.
33.
AltmanLHopkinsRJAhmedS: Stability of morphine sulfate in Cormed III (Kalex) intravenous bags. Am J Hosp Pharm47:2040–2042, 1990.
34.
KowalskiSRGourlayGK: Stability of fentanyl citrate in glass and plastic containers and in a patient-controlled delivery system. Am J Hosp Pharm47:1584–1587.
35.
DuafalaMEDleinbergMLNacavLC: Stability of morphine sulfate in infusion devices and containers in intravenous administration. Am J Hosp Pharm47:143–146, 1990.
36.
StilesMLTuYHAllenLV: Stability of morphine sulfate in portable pump reservoirs during storage and simulated administration. Am J Hosp Pharm46:1404–1407, 1989.
37.
WalkerSECoonsCMatteD: Hydromorphone and morphine stability in portable infusion pump cassettes and minibags. Can J Hosp Pharm41:177–182, 1988.
38.
SimmonsBPHootonTMWongES: Guidelines for prevention of intravascular infections. Hosp Infect Control9:28j–28p, 1982.