(it is not possible to request specific passwords, sorry)
Click here to report a message
Welcome to the Discussion Forum section of www.pain-talk.co.uk
|
||
| Return to Website | ||
 First |
 Prev |
 Reply |
 Home |
Next  |
Last  |
| Viewing Page 1 of 1 (Total Posts: 9) |
| Author | Comment |
Angela
 Jul 24, 07 - 11:10 AM |
spinal opioids
We currently do not use opioids in spinal anaesthetics for joint replacements but are considering introducing this. Can anyone help with the following information : what drugs are used intrathecally and what doses intra-operatively? what observations are completed post-operatively, where are these observations recorded and who records them? what additional analgesics are permitted have you come across any problems - especially with respiratory rates? Thank you 
|
|
Jane Donn
Jul 24th, 2007 - 1:41 PM |
Re: spinal opioids
Hi Angela We routinely put Diamorphine into our spinals for joint replacement. We found epidurals restricted mobilisation on day 1. We use 0.3-0.5 mg (varies with individual patient). Our audit shows that this provides, for most patients, very good analgesia for up to 12 hours. We then either give them a PCA which they start to use when "pain returns" or as they can eat and drink quite quickly, oral analgesia. We do the same observations as you would expect post-operatively (never go less than 4 hourly for the first 24 hours)and we have had no incidents of respiratory depression. We get the occasional hypotension where a patient feels so well they sit up too quickly. We make no hard and fast rule about sitting up - the nurse judge each patient individually by B/P etc. Hope this is of interest. Jane |
|
Roger
Dec 12th, 2007 - 5:06 PM |
Re: Re: spinal opioids
Dear Jane, Am keen to introduce routine use of intrathecal diamorphine for our TKRs and THRs. At present most anaesthetists use blocks only, which are usually inadequate. My colleagues are cautious about long acting intrathecal opioids and it would help enormously if you would send me copies of any audits and guidelines you have for their use intra op and monitoring post op. Thanks very much, Roger |
|
Ros
Jul 24th, 2007 - 3:00 PM |
Re: spinal opioids
Hi Angela, We use diamorphine up to 1mg intrathecally for joint replacement. we ask our ward staff to do routine observatios as for epidural opiates and PCA. If another opiate is given parentrally within the next 24hrs observations of resp rate and sedation levels are increased. Some patients receive morphine PCA and others have IM morphine prescribed. We have not had any problems with low respiratory rates or oversedation but we have seen occasional pruritis. Ros. |
|
Sarah
Jul 26th, 2007 - 1:22 PM |
Re: spinal opioids
Hi We use 200-500mcg of diamorphine and sometimes fentanyl. We have recently written some guidlenes for stepping down onto oral oxycontin/oxynorm instead of PCA as we found they were not been used. (elective hip and knee replacements) Diamorphine is superior to fentanyl. We use 7.5mg of oxnorm on the day of surgery then day one post op they go onto 10mg oxycontin BD with oxynorm for rescue. After intrathecal opiods our patients should have obs hourly for 12 hours. We have a chart just for these patients. 
|
|
Tina
Aug 7th, 2007 - 3:03 PM |
Re: spinal opioids
hi we have used ITO for orthopaedic patients for 2 years THR 200mcg morphine TKR 300-400mcg morphine, however our nausea rate is around 30-40% despite giving on intra operative ondansetron or/granisetron. we have recently starting using peripheral nerve blocks 3:1 femoral/sciatic and have improved pain scores with out the adverse effects of PONV, pruritis, and dizziness. 
|
|
Steve
Dec 13th, 2007 - 12:33 PM |
Re: spinal opioids
I would love to stop the use of intrathecal opioids. Research shows that the opioid effect is in fact systemic and good analgesia can be obtained with a plain spinal block if regular paracetamol and NSAID are given. If patients are still experiencing pain they can be topped up with either oral or IV opioids that can be titrated to effect. This also ensures that there is no possibility of late onset respiratory depression that can be a side effect of spinal opioids. |
|
Vivienne
Dec 20th, 2007 - 10:31 AM |
Re: spinal opioids
Steve,why are you so keen to ban opioids from spinals? Have you experienced any problems? I have ben using first morphine and later diamorphine intrathecally for at least fifteen years for mainly THRs and TKRs. I have never had any complication other than the occasional pruritis (rare). I know there is speculation that some of the effect may be systemic but in some cases the patients have had up to 24 hours analgesia which one couldn't achieve with 0.5 mg diamorphine IV/IM. The patients are also able to mobilise earlier than with a block(which is a bit hit& miss even with a nerve stimulator). Also discussing with patients afterwards that have had another type of analgesia for the other limb, the majority preferred the spinal. |
|
Jason
Jan 22nd, 2008 - 12:06 PM |
Re: spinal opioids
We have audit data of almost 3000 THR and TKR using between 0.25 and 1 mg IT diamorphine with good efficacy and reasonable side-effect profile . No major respiratory depression. Please contact me for more info if needed. |
| First |
Prev |
Reply |
Home |
Next |
Last |
powered by
bravenet.com