ABSTRACT
Not practically suitable for intermittent bolus technique unless PCA. Best system is a slow bolus to control pain followed by infusion to maintain serum levels. Patients need regular assessment to ensure both adequate analgesia and that overdosage is not occurring. Dependent upon reliability of syringe driver. Large amount of opioid in syringe at beginning: beware tampering, theft, etc. by third persons
Mainly opioids (PCA described separately in text)
Epidural (opioid)
If opioids are used alone there is the potential for analgesia without sensory, motor; or deficits. Able to work on autonomic specific dermatomes. Catheter normally inserted
Potential for delayed respiratory depression. May not control some types of pain. Needs appropriate nursing area
Can be very effective, especially if opioids combined with local anaesthetics. More fat-soluble compounds (diamorphine, fentanyl) produce respiratory depression earlier than less fatsoluble ones (morphine). Other disadvantages are pruritus, urinary retention, nausea, vomiting and reduced peristalsis, and sedation. Can be administered by bolus, infusion, or PCA. Respiratory depression can result from additional opioids given by other
Many analgesic compounds used but now almost exclusively opioids, which may be combined with local anaesthetics
intramuscular) routes
Intrathecal (opioid)
As for epidural but normally ‘single shot’
As for epidural The less lipidsoluble compounds (e.g. morphine) last for up to 24 hours which is an advantage if only bolus dose given. Otherwise as for epidural route. Almost always single-shot but intrathecal catheters are available and used in some centres
Opioids may be combined with local anaesthetics
Intraarticular (opioid)
Put in at the end of joint surgery. Low dose with few systemic effects
Effectively oneshot only
Good for procedures such as arthroscopy, etc.
