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به نام خدا

Two mechanisms of epidural opioid analgesia 1 – spinal and supraspinal analgesia 2 – systemic analgesia Opioids that diffuse into ; a- epidural fat ? and veins….plasma…..brainstem. b- spinal meninges diffuse

PCEA

Side effects of epidural opioids 1 – respiratory depression(0.1 – 0.9%) 2 – nausea & vomiting( single=20 - 50% & conti.45 - 80%) 3 – pruritus(60%) 4 – urinary retention(70 - 80%) 5 – HYP0TENTION ? -

Factors that may Increase respiratory depression 1 – thoracic surgery 2 – comorbidities 3 – age 4 – opioid-nave state 5 – systemic opioid & sedatives

EXTENDED-RELEASE EPIDURAL MORPHINE EREM may provide analgesia for 48 hr after a single dose LA shoud not be administration immediately after injection of a EREM Interaction may be minimized by waiting 15 min after a LA dose before injection the EREM

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