With the knowledge base expanding in pain management, about 95% of
patients can be adequately managed. The use of opioids, the
understanding of opioid resistant pain and the role of adjuvant
therapy contribute to this high success rate of pain control. The
remaining 5% with pain has to be dealt with differently. The
applications of invasive options would have to be used to control
pain.There are two methods for invasive pain management.
1. The spinal administration of opioids, local anaesthetics and
adjuvant drugs.
2. Destructive neurolytic blocks.
What are the indications for spinal opioids?
Morphine sensitive pain, morphine insensitive pain, neuropathic
pain, morphine hyperalgesia.
What other opioid drugs can be used spinally?
Fentanyl, hydromorphone.
What are spinal local anaesthetics?
Morphine, fentanyl, bupivacaine, lignocaine, long acting
ropivacaine
What are the two modes of intrathecal infusions of local
anaesthetics?
Continuous or with patient controlled administration.
What are the indications for intrathecal local anaesthetics?
First, metastatic vertebral crush fractures with nerve root
compression. Second, perineal and abdominal tumours together with
invasive spinal tumours such as cordomas and sarcomas.
What are the adjuvant spinal analgesics?
Clonidine, NMDA antagonists such as ketamine, MK 801 and CPP (carboxy
propyl phosphonic acid) together with novel agents such as the
cone shell omega peptide SNX 111 which is a neurone specific
Calcium channel blocker.
What are the techniques for adminstering spinal drugs?
Epidurally, intrathecally, or intraventricularly.
The second form of invasive pain management, neurolytic blocks
will be discussed in the next article.
If you have questions related to this article you may e-mail me
at doctor@soontongkiong.com quoting the contents of the article.
About the author
DR SOON is a medical practitioner. He holds four degrees. MBBS
(University of Malaya), MBA (University of East Asia), LLB (Hons)
(University of Wolverhampton), Master of Medicine (Edith Cowan
University
:
Dr SOON is the owner of AskMyVisitor.com and MyScriptDoctor.com
where you can find the most up-to-date advice and information
on
many medical, health and lifestyle topics.
