Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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The advantages and disadvantages associated with epidural opioids require careful selection of the opioid and its dosage. There is presently no ideal opioid available for epidural use. Comparative pharmacokinetic data help to select the appropriate epidural opioid. ⋯ Epidural morphine treatment is an alternative to step 4 of the WHO treatment regimen for patients with intractable pain or those suffering from systemic opioid side effects. Careful selection of patients helps to increase successful treatment. If implantable devices (ports or pumps, according to the life expectancy) are employed, the intrathecal route of administration is preferable to the epidural route, as the latter has a 10 times higher morphine dose requirement.
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Pain therapy is a central medical task and a legal duty. Not the anaesthetist but the pain-causing surgeon is responsible for therapy of pain. Pain as a negative sensation is subjective and individual. ⋯ Opioids are used with caution in abdominal surgery because of their negative effects (obstipation), the same is the case with Novalgin in trauma patients because of its effect on temperature and leukopenia. Patient-controlled analgesia with appropriate devices means further progress for suitable patients. Effective pain therapy within the framework of successful surgery is feasible and influences patients' comfort and possibly even their morbidity and mortality.