Articles: analgesia.
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Spinal opioids have dramatically changed the way acute, obstetrical and pain of malignant origin is managed. The development of various implantable narcotic delivery systems has complemented and facilitated the growth of this treatment modality. By interfacing appropriate patient selection with the unique advantages and disadvantages of each of the six types of implantable narcotic delivery systems, improved results both in terms of pain relief and patient satisfaction can be achieved.
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The use of spinal opioids in the management of acute pain is now widely accepted. The development of acute pain services has provided standardized approaches to the management of this modality. This article discusses technical considerations, monitoring, and benefits of this approach.
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Nursing care of the patient receiving spinal opioids for pain control is reviewed in a comprehensive manner. Selection of patients, nursing management and patient outcomes are discussed. Three pain control techniques are described: epidural opioid injection for cancer pain, epidural opioid infusion for acute postoperative pain, and single dose spinal opioids for postcesarean section pain. Monitoring and pharmacologic aspects common to all three forms of spinal opioid treatment are given, and specific nursing interventions for each therapy are delineated.
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The outpatient management of spinal opioids presents multiple challenges to the home infusion pharmacist. These include compounding, Schedule II prescription control, dispensing for long-term infusion or injection, reimbursement, and the management of opioids in the home. Although spinal opioids such as meperidine, fentanyl, and methadone have been used to control intractable pain, preservative-free morphine is the preferred opioid for epidural and intrathecal injection. ⋯ Spinal opioids can be administered intermittently, by continuous infusion, or patient-controlled analgesia pump. Extensive clinical experience indicates that the home administration of spinal opioids is safe and effective. There is a need for additional research on stability, storage and use of various opioids administered in the home environment.