Journal of pain and symptom management
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This review presents the pharmacology of spinal opioid receptor systems which are primarily involved in pain processing. The major areas upon which we will focus are: the structure and cellular functioning of the opioid receptor systems; the physiologic effects induced by spinally administered opioids, particularly in pain modulation; and pharmacokinetic and dynamic considerations, with special attention to the problem of opioid tolerance development.
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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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This article reviews the currently published articles regarding the use of spinal opioids in pediatric patients and discusses the important clinical considerations for the application and monitoring of this technique in children.
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Spinal opioids have become increasingly popular agents for providing analgesia during labor, augmenting anesthesia during cesarean section, and providing pain relief after operative delivery. The development of spinal opioids in the management of obstetric pain is reviewed.
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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.