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If the patientison intrathecal opioidmake Shure itshandedover.Make Shure no opioidis givenin
the first24 hours,exceptthe recoveryanalgesiaunlessthe patientisreviewedbyadoctor.
If the patienthaspainand require opioidanalgesiawithinthe first24 hoursreview the patientspain
score,sedationscore andrespiratoryrate and the,if appropriate,the startthe PCA,butensure no
backgroundinfusion after doublecheckwithsenior doctor
Morphine
In anaesthesiamorphine isusedtorelievepain.This isan effectof itsactionon the spinal cordto
decrease the transmission of painful stimuli frombodytobrainand itsactionwithinthe brain
itself.
A single dose of epiduralmorphinemayrelieve painfor12-24 hours.The main riskof thistechnique
isthat severe respiratorydepressionmayoccurup to 18 hoursafterthe initial injection becauseof
the slowcirculationof cerebral spinal fluidwhichcarriesthe morphine uptothe brainto act onthe
respiratorycentre.
These are a mandatorysetof observationswhichmustbe carriedoutinthe 24hrs post
administrationof anyspinal opioid,andfollow the pre-existingpainguidelinesforthe management
of patientswhohave receivedspinalopioids. The observationsare carried out hourly for the first
12hrs post administrationof the spinal opioid and then2 hourlyupto 24hrs postadministration:
- AVPUscale.Target: Alertor Voice. UnlesspatientasleepandRR>12.
- Respiratory rate. Target >12.
- Oxygensaturation. Target >95%.
Complications
Slowrespiratoryrate anda verysleepypatientwithpinpointpupils
Oxygenshouldbe givenbyface mask andpositive pressureventilationof the lungsstartedif
necessary.
NALOXONE 100-400 microgramsmay be givenintravenouslyif available.
SPINAL ANAESTHESIA
Spinal anaesthesiaisinducedbyinjectingsmallamountsof local anaestheticintothe cerebro –spinal
fluid(CSF).The injectionisusuallymade inthe lumbarspine below the level atwhichthe spinal cord
ends(L2). Spinal anaesthesiais easy to performand has the potential to provide excellent
operatingconditionsfor surgerybelowthe umbilicus.
Local anaestheticsolutioninjectedintosubarachnoidspace blocksconductionof impulsesalongall
nerveswithwhichitcomesincontact- motor,sensoryand autonomic
Generallyautonomicandpainfibresare blockedfirstandmotorfibres last.This hasseveral
importantconsequences.Forexample ,vasodilationanda drop in bloodpressure may occur when
autonomic fibresare blocked and the patientmaybe aware of touch and yetnopain whensurgery
starts.
Local anaestheticfor spinal anaesthesia
Bupivacaine (Marcaine) isthe local aestheticmostcommonly used;usuallylastfor2to 3 hours.
An anotherlocal aestheticislignocaine
Drugs to improve the qualityof block or for post operative pain relief
Fentanyl,morphine.

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Morphine

  • 1. If the patientison intrathecal opioidmake Shure itshandedover.Make Shure no opioidis givenin the first24 hours,exceptthe recoveryanalgesiaunlessthe patientisreviewedbyadoctor. If the patienthaspainand require opioidanalgesiawithinthe first24 hoursreview the patientspain score,sedationscore andrespiratoryrate and the,if appropriate,the startthe PCA,butensure no backgroundinfusion after doublecheckwithsenior doctor Morphine In anaesthesiamorphine isusedtorelievepain.This isan effectof itsactionon the spinal cordto decrease the transmission of painful stimuli frombodytobrainand itsactionwithinthe brain itself. A single dose of epiduralmorphinemayrelieve painfor12-24 hours.The main riskof thistechnique isthat severe respiratorydepressionmayoccurup to 18 hoursafterthe initial injection becauseof the slowcirculationof cerebral spinal fluidwhichcarriesthe morphine uptothe brainto act onthe respiratorycentre. These are a mandatorysetof observationswhichmustbe carriedoutinthe 24hrs post administrationof anyspinal opioid,andfollow the pre-existingpainguidelinesforthe management of patientswhohave receivedspinalopioids. The observationsare carried out hourly for the first 12hrs post administrationof the spinal opioid and then2 hourlyupto 24hrs postadministration: - AVPUscale.Target: Alertor Voice. UnlesspatientasleepandRR>12. - Respiratory rate. Target >12. - Oxygensaturation. Target >95%. Complications Slowrespiratoryrate anda verysleepypatientwithpinpointpupils Oxygenshouldbe givenbyface mask andpositive pressureventilationof the lungsstartedif necessary. NALOXONE 100-400 microgramsmay be givenintravenouslyif available.
  • 2. SPINAL ANAESTHESIA Spinal anaesthesiaisinducedbyinjectingsmallamountsof local anaestheticintothe cerebro –spinal fluid(CSF).The injectionisusuallymade inthe lumbarspine below the level atwhichthe spinal cord ends(L2). Spinal anaesthesiais easy to performand has the potential to provide excellent operatingconditionsfor surgerybelowthe umbilicus. Local anaestheticsolutioninjectedintosubarachnoidspace blocksconductionof impulsesalongall nerveswithwhichitcomesincontact- motor,sensoryand autonomic Generallyautonomicandpainfibresare blockedfirstandmotorfibres last.This hasseveral importantconsequences.Forexample ,vasodilationanda drop in bloodpressure may occur when autonomic fibresare blocked and the patientmaybe aware of touch and yetnopain whensurgery starts. Local anaestheticfor spinal anaesthesia Bupivacaine (Marcaine) isthe local aestheticmostcommonly used;usuallylastfor2to 3 hours. An anotherlocal aestheticislignocaine Drugs to improve the qualityof block or for post operative pain relief Fentanyl,morphine.