What is opioid induced hyperalgesia? Patients receiving opioids to control their pain somewhat paradoxically may become more sensitive to pain (i.e., hyperalgesic) and may aggravate their preexisting pain as a direct result of opioid therapy. The disappearance of opioid treatment effects, particularly if coupled with the unexplained expansion of pain complaints, may signal the expression …
Is the thoracic paravertebral block superior to thoracic epidural analgesia? TEA has been traditionally regarded as the “gold standard.” A growing body of evidence supports that thoracic paravertebral block (TPVB) is at least comparable to TEA for postoperative analgesia in thoracic and abdominal surgeries with a superior side effect profile, avoiding epidural hematoma and abscess, …
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What are the specific goals of postoperative pain management after total knee arthroplasty? The goals extend beyond simply improving patient comfort and satisfaction. It is essential to enable patients to ambulate and move their joints soon after surgery and, where appropriate, to shorten the length of stay, in many cases allowing patients to be discharged …
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How to treat opioid related respiratory depression in the postoperative setting? Opioids activating the µ receptor cause dose-dependent depression of respiration, primarily through a direct action on brainstem respiratory centers. Naloxone was introduced into clinical practice in the late 1960s. Side effects (increases in heart rate and blood pressure) and more serious complications (e.g., pulmonary …
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What are your options to treat opioid induced nausea and vomiting? Nausea is a highly distressing symptom that may occur with or without vomiting and can affect overall outcome. Opioid-induced nausea and vomiting (OINV) may be due to multiple opioid effects, including (a) enhanced vestibular sensitivity (symptoms may include vertigo and worsening with motion), (b) …
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Which opioid neuraxial administration has higher chances of resulting in delayed respiratory depression? Why? Neuraxial administration of lipophilic opioids, such as fentanyl and sufentanil, provides a rapid onset of analgesia, and their rapid clearance from cerebrospinal fluid (CSF) may limit cephalic spread and the development of certain side effects such as delayed respiratory depression. On …
What are the special considerations of opioid use for postoperative pain control with children? The emotional component of pain is particularly strong in infants and children. Absence of parents, security objects, and familiar surroundings may cause as much suffering as the surgical incision. Children’s fear of injections makes intramuscular or other invasive routes of drug …
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