1. به نام خدا

2. 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

7. PCEA

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

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

11. 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

12. خسته نباشید