Current opinion in anaesthesiology
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In recent years there has been a renewed interest in regional anaesthesia, particularly peripheral nerve blockade, not only to improve the patient's well being, but also to meet the requirements of modern orthopaedic surgery. Nerve injury in this context is the complication most feared by the patient, the anaesthesiologist and the surgeon. ⋯ Significant advances have been made in regional anaesthesia in the past 10 years. The introduction of catheter techniques has cleared the way for better regional anaesthetic and analgesic blocks. Studies dealing with placement of perineural catheters show that the catheter does not increase neurological complications. Properly performed, regional anaesthesia is a safe form of anaesthesia and the benefits far outweigh the risks.
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Curr Opin Anaesthesiol · Oct 2004
Recent insights into the pharmacokinetics of spinal opioids and the relevance to opioid selection.
Spinal opioid administration was introduced into clinical practice nearly 25 years ago in the hope of producing intense spinal analgesia that was devoid of the dose-limiting side effects associated with systemic opioid administration. While spinal opioid administration can clearly be an effective analgesic technique, there is a widespread misconception that any opioid administered epidurally or intrathecally will produce analgesia by a selective spinal mechanism. This is simply not true; multiple opioids that are commonly administered spinally produce analgesia by uptake into the systemic circulation with subsequent redistribution to brainstem opioid receptors. In an effort to help clinicians understand why some opioids are not suitable for selective spinal analgesia, this review describes recent insights into the fate of intrathecally and epidurally administered opioids. ⋯ These animal data help to explain multiple clinical studies that have demonstrated that the analgesic effect of spinally administered lipid-soluble opioids is due in part, if not exclusively, to uptake into plasma and distribution to brainstem opioid receptors.
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This review of the most recent publications is aimed to look at the current developments regarding the effects of regional anesthesia on perioperative outcome. ⋯ Despite the controversies, the numerous potential benefits and advantages of regional anesthesia are keys to its continued popularity. With constant search for new scientific clues by improving experimental designs, valuable evidence slowly unfolds. Regional anesthesia certainly takes a leading role in the current trends for a multimodal approach of perioperative pain management.
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Morphine metabolites have attracted continuing interest for their contribution to the desired and unwanted effects of morphine. Among the metabolites of morphine, morphine-6-glucuronide has been given most scientific attention. It accounts for 10% of the morphine metabolism, acts as an agonist at mu-opioid receptors and exerts antinociceptive effects. This review summarizes the recent findings on morphine-6-glucuronide and discusses its potential use as an analgesic. ⋯ Morphine-6-glucuronide might qualify as an analgesic but it has several pharmacological properties that make it far from ideal for therapeutic use. Whether it will be a useful addition to the currently established analgesics has yet to be demonstrated.
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Intraoperative neurophysiologic monitoring provides useful information on the functional status of the nervous system. This review focuses on recently published data concerning the impact of monitoring on patient outcome. ⋯ Brain monitoring facilitates anesthetic drug administration. An increasing number of neurosurgical procedures will require some form of intraoperative neurophysiologic monitoring to achieve higher degrees of safety and accuracy. In many instances, the data derived from monitoring will guide and influence surgical decisions. In this context, neurophysiologic monitoring should be regarded as interventional.