Epidural and intrathecal administration

Epidural analgesia has been shown to improve outcome in high-risk patient populations ( Lui ei a/ 1995).

Epidural and subarachnoid administration of local anesthetics and opioids may be as single agents or in combination. Subarachnoid administration with local anesthetics is used for many surgical procedures but has a short duration of action. Continuous infusion may be used but requires close monitoring. Clinically significant analgesia is achieved with subarachnoid administration of opioids, for example morphine 0.5 to1 mg with a duration of action of 8 to 24 h. Bupivacaine has been the local anesthetic of choice for epidural infusion. A low concentration (e.g. 0.125 per cent) with opioid minimizes motor block. Fentanyl is highly lipid soluble and thus needs to be administered close to the appropriate spinal cord segments. Morphine is less lipid soluble and thus can be administered in the lumbar region, from which it will spread cranially to treat thoracic, cervical, or head pain.

Ropivacaine is a new enantioselective local anesthetic with greater sensory-motor separation, less cardiotoxicity, and higher clearance than bupivacaine, thus offering distinct advantages over bupivacaine.

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