Chapter 32 Intra-Articular and Intraperitoneal Opioids for Postoperative Pain Flashcards Preview

Essentials of Pain Medicine > Chapter 32 Intra-Articular and Intraperitoneal Opioids for Postoperative Pain > Flashcards

Flashcards in Chapter 32 Intra-Articular and Intraperitoneal Opioids for Postoperative Pain Deck (18):

intra-articular NSAIDs

NSAIDs have consistently demonstrated a benefit in modulating postoperative
pain when injected IA, yet there is a concern that
they may inhibit or retard bone healing


intra-articular Clonidine

use of the alpha-2 agonist clonidine IA has demonstrated a modest and limited reduction in postoperative pain, although the same controversy exists as to whether these benefits are
mediated systemically or are local phenomena


The effects of IA opioids may be mediated through

the G-protein–coupled receptors affecting the cAMP pathway. Stimulation of chondrocytes with beta-endorphin resulted in decreased phosphorylation of
the transcription factor cAMP responsive element binding
protein (CREB), an effect reversible by naloxone


Benefit of IA morphine added as a component of multimodal analgesia following arthroscopic ankle surgery

there was a significant reduction in pain, joint swelling, time of immobilization, duration of sick leave, and return to physical activity.



synthetic opioid agonist at m- and k-opioid receptors derived from phenylepiperidine


Structurally, meperidine
is similar to

atropine, and it possesses a mild atropine-like
antispasmodic effect.


Meperidine vs. Morphine

It is about one-tenth as potent as morphine and its duration of pharmacologic action is
about 2 to 4 hr.


IA Meperidine

Meperidine has been injected IA in doses of 10 to 200 mg, alone or in combination with local anesthetics and tenoxicam.


Fentanyl vs. Morphine

fentanyl is about 75 to 100 times more potent than morphine. A single dose of fentanyl administered intravenously has a more rapid onset than morphine and a
shorter duration of clinical effect, although the elimination
half-life is longer than that of morphine.


IA Fentanyl

IA bupivacaine was noted to provide superior analgesia
compared to IA fentanyl in the immediate postoperative
period, for up to 2 hr, following knee arthroscopy


Sufentanil vs Fentanyl

sufentanil has a greater affinity for opioid receptors than fentanyl,and is about 12 times as potent. Sufentanil is extensively protein bound (92.5% vs. fentanyl at 79% to 87%) and is highly lipid soluble. Its elimination half-life is intermediate between that of fentanyl and alfentanil


IA Sufentanil and Fentanyl

conclusion, IA fentanyl analgesia in doses up to 100 mg
or sufentanil up to 10 mg both appear to be modestly
successful in modulating nociception after knee arthroscopy.



Tramadol is a synthetic narcotic with a weak mu-receptor
agonist activity. It also enhances the function of the spinal
descending inhibitory pathway by inhibition of reuptake
of both 5-hydroxytryptamine (5-HT) and norepinephrine
and stimulate the presynaptic release of 5-HT


IA tramadol

IA tramadol 100 mg appears to
have analgesic effects after knee arthroscopies and medial


order of IP (intraperitoneally) potencies

remifentanil > alfentanil > morphine, while
the duration of analgesia was morphine > > alfentanil >


side effect profiles were best with

> alfentanil > remifentanil


clinical significance
of these finding of INTRAPERITONEAL OPIOID

The clinical significance
of these findings may be simply that the highly
lipid-soluble agents are potent analgesics when administered
IP, but are also associated with greater risk


IP opioids have been used following

laparoscopic cholecystectomy,
laparoscopic gynecologic surgery, and after open intra-abdominal procedures.

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