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Postoperative Epidural Opioids - Joachim Chrubasik

Paperback ISBN: 9783540568711
Number Of Pages: 119

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Epidural opioids are widely used in the management of post- operative pain. On the basis of an extensive review of the literature the authors here present their own interpretation of current knowledge of how the distribution and effectiveness of epidurally administered opiods are fundamentally determined. They conclude that all opioids that are currently being used to treat postoperative epidural pain carry the potential risk of severe side effects if the dose regimens are not tailored to the patient`s individual analgesic need. This book will serve to stimulate new ideas among pain specialistst.

Introductionp. 1
Epidural and Intrathecal Spacep. 3
Anatomyp. 3
Puncture of the Meningesp. 5
Distribution of Solutionsp. 8
Determinants of Opioid Activityp. 9
Physicochemical Propertiesp. 11
Distribution and Eliminationp. 14
Opioid Receptorsp. 16
Supraspinal Receptor Sitesp. 16
Spinal Receptor Sitesp. 18
Receptor Affinitiesp. 19
Receptor Binding Kineticsp. 22
Opioid Pharmacokinetics After Epidural Administrationp. 25
Transfer Across the Meningesp. 25
Uptake into the CSFp. 26
Distribution within the CSFp. 27
Elimination from CSFp. 32
Uptake into Spinal Cord and Brainp. 32
Uptake into Epidural Fatp. 33
Vascular Uptake into the Systemic Circulationp. 34
Following Epidural Bolus Injectionsp. 34
During Continuous Epidural Opioid Treatmentp. 37
Elimination from Bloodp. 40
Clinical Implicationsp. 43
Onset Time of Analgesiap. 43
Duration of Actionp. 45
Injection Volumep. 53
Addition of Epinephrinep. 53
Side-Effectsp. 54
Pruritusp. 55
Urinary Retentionp. 56
Early Respiratory Depressionp. 56
Late Respiratory Depressionp. 57
Treatmentp. 62
Quality of Analgesiap. 62
Relative to Systemic Opioidsp. 62
Injection Volumep. 63
Addition of Local Anestheticsp. 64
The Optimum Dosage Regimenp. 67
Relative Analgesic Potenciesp. 73
Definitionp. 73
Quantitation from Postoperative Dose Requirementsp. 73
Interpretationp. 77
Risk-Benefit Evaluationp. 85
Morphinep. 85
Meperidinep. 87
Methadonep. 88
Alfentanilp. 89
Fentanylp. 90
Sufentanilp. 91
Buprenorphinep. 92
Tramadolp. 93
Referencesp. 97
Table of Contents provided by Blackwell. All Rights Reserved.

ISBN: 9783540568711
ISBN-10: 3540568719
Audience: General
Format: Paperback
Language: English
Number Of Pages: 119
Publisher: SPRINGER VERLAG GMBH
Country of Publication: DE
Dimensions (cm): 23.39 x 15.6  x 0.74
Weight (kg): 0.2