Intrathecal administration is delivered directly into the CSF and into the superifical spinal cord; epidural administration diffuses through the dura into the CSF, and thus has a slower onset of action.
Which of the following are complications that can occur from epidural or intrathecal analgesia?
Medication-related complications include nausea, vomiting, pruritus, motor block, hypotension, and respiratory depression. Catheter-related complications include catheter failure/dislodgement, intrathecal or intravascular migration, and epidural hematoma or abscess.
Is intrathecal better than epidural?
Conclusions: Published studies suggest that intrathecal opioids provide comparable early labor analgesia when compared with epidural local anesthetics. Intrathecal opioid administration results in a greater incidence of pruritus. The choice of technique does not appear to affect the method of delivery.
What is the most serious complication of epidural analgesia?
The most common complications occurring with epidural analgesia are maternal hypotension and postdural puncture headache. Retrospective studies have demonstrated an association between epidural analgesia and increases in duration of labor, instrumental vaginal delivery and cesarean section for labor.
How is an intrathecal injection given?
Once your skin is numb, the anesthesiologist places a special needle into your back and into the spinal space. This space is just outside the spinal cord. He or she will inject the medicine into this space. The anesthesiologist removes the needle and will place a bandage as needed.
What medications are used in intrathecal pain pumps?
Medications used in your pump include:
- Opioids – Morphine and Hydromorphone (Dilaudid) are often used.
- Local anesthetics (i.e. Bupivacaine) – This medicine blocks pain signals in the spinal cord.
- Clonidine – This medicine can also lower blood pressure and also relieves pain.
What are some of the risk of intrathecal or epidural narcotics?
The four classic side effects are pruritus, nausea and vomiting, urinary retention, and respiratory depression. Numerous other side effects have also been described.
What is the most common complication of spinal anesthesia?
The most common are postdural puncture headache and hypotension. Hypotension after spinal anesthesia is a physiological consequence of sympathetic blockade. The diagnoses and management of these sequelae are discussed.
When should an intrathecal catheter be removed?
The intrathecal catheter may be left in for up to 24 hours. If the catheter remains in situ it must be capped and clearly labeled to prevent inadvertent injection in the catheter and an order left with specific instructions on when to remove the catheter.
What is intrathecal pain?
An intrathecal pain pump implant is a way to relieve some kinds of long-term (chronic) pain or cancer pain. It sends pain medicine through a thin, flexible tube. The tube is inserted into the space around the spinal cord.
What are the long term side effects of epidural?
The most frequently reported maternal effects of epidural or spinal analgesia are prolonged symptoms of headache, backache and neurological sequelae. Large retrospective studies of postpartum symptomatology have focused on correlations with regional nerve blockade rather than on other more commonly used analgesics.
What happens when epidural goes wrong?
Nerve damage The needle used to deliver the epidural can hit a nerve, leading to temporary or permanent loss of feeling in your lower body. Bleeding around the area of the spinal cord and using the wrong medication in the epidural can also cause nerve damage. This side effect is extremely rare.
What is the difference between epidural and intrathecal analgesia?
Epidural analgesia is the administration of analgesics into the epidural space. Analgesics can be given either as a single injection or as a continuous infusion via an indwelling catheter. Intrathecal analgesia is the administration of analgesic drugs (as listed above) directly into the CSF in the intrathecal space.
What are the indications for intrathecal therapy in chronic pain management?
Chronic or persistent non-malignant pain may be managed with neuraxial interventions. Clinical indications for intrathecal therapy in CNMP include neuropathy (post-herpetic neuralgia and peripheral neuropathy), mixed neuropathic–nociceptive pain, radicular pain from failed back syndrome and complex regional pain syndrome (CRPS).
What are the long-term outcomes of intrathecal opioid therapy for pain management?
Long-term outcomes of intrathecal opioid therapy were studied by Kumar et al.8and Thimeneur et al.9and both reported improvements in pain, mood and function from the baseline. Kumar et al.8reported an average pain reduction after 6 months of 67.5% and at the last follow-up (range 13–49 months) of 57.5%.
What is the difference between the pia mater and epidural space?
The pia mater covers the spinal cord and the arachnoid mater lies closely adherent to the outer, tough, dura mater.3The epidural space lies outside all three membranes.
