neuraxial opioids
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| Describe anatomically how a CRNA would give an epidural neuraxial opioid dose? | Needle would go through the ligamentum flavum but not through the drug mater; it is a theoretical space
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| Describe anatomically how a CRNA would give a spinal neuraxial opioid dose? | Needle would go though the dura mater and into the subarachnoid space; you would know you have reach subarachnoid space r/t aspiration of CSF
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| Which receptors are present in high concentrations in the dorsal horn of the spinal cord? | mu, kappa, and delta
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| Which are the main receptors present in the substantial gelatinosa? | mu
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| The epidural dose should be _____ the subarachnoid dose | 5x - 10x
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| What is the epidural dose of morphine? The spinal dose? | epidural: up to 5 mg; spinal: 0.25 - 1 mg
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| Neuraxial analgesia is specific for ______ pain rather than _______ pain | visceral; somatic
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| True or false: neuraxial opioid analgesia does NOT include a sympathetic denervation, skeletal muscle weakness, or loss of perception of pressure | True!
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| If you are going to give morphine in the epidural space or subarachnoid space, you must ensure that it is what? | preservative free
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| What is the mechanism of action of opioids placed in the epidural space? | they diffuse across the dura to affect mu receptors on the spinal cord and are absorbed systemically to produce effects like IV opioids
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| The higher the lipid solubility of an opioid given epidurally, the _____ absorption systemically | more
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| Why is morphine typically the drug of choice for epidural administration? | lower lipid solubility means slower onset, but longer duration
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| The more lipid soluble, the _______ the diffusion into the CSF | faster
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| When does epidural fentanyl reach peak CSF concentration? | 20 minutes after epidural administration
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| When does epidural Sufentanil reach peak CSF concentration? | 6 minutes after epidural administration
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| When does epidural morphine reach peak CSF concentration? | 1 - 4 hours after epidural administration
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| What percentage of epidural dose of morphine enters the CSF? | only 3%
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| When does fentanyl reach peak blood concentration after epidural administration? | 5 - 10 minutes
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| When does sufentanil reach peak blood concentration after epidural ministration? | < 5 minutes
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| When does morphine reach peak blood concentration after epidural administration? | 10 - 15 minutes
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| How can you decrease vascular absorption of epidural opioid? | by injecting epinephrine into the epidural space along with the opioid; vasoconstriction = less absorbed into vasculature
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| If epinephrine is added to the morphine solution injected into the subarachnoid space, what happens to the analgesic effect? | it is enhanced compared with the injection of morphine alone because it stays there longer and is not taken up into the vasculature as readily r/t vasoconstriction
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| What is the dose and duration of epidural fentanyl? | 50 - 100 mcg; duration: 1 - 3 hours
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| What is the dose and duration of epidural morphine? | 2 - 5 mg; duration: 4 - 24 hours
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| ___________ affects the degree of cephalad movement of opioids in the CSF | lipid solubility (higher lipid solubility limits movement)
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| True of false: body position accelerates cephalad movement of opioids in CSF | False! coughing or straining can accelerate movement
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| Are side effects of neuraxial opioids due to the presence of them in the CSF or in systemic circulation? | either in CSF or systemic circulation
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| What are the four classic side effects of neuraxial opioids? | pruritis, N/V, urinary retention, depression of ventilation
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| What can occur 2 - 5 days post epidural administration of morphine? | reactivation of herpes virus; r/t cephalad movement of opioid and interaction of trigeminal nucleus
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Created by:
Mary Beth
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