Epidural Administration Of Opiates

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Side effects such as sedation, slowed breathing, and reduced blood pressure often result when opiates are given by mouth or by injection. However, in certain situations, such as during childbirth, the patient needs to be alert and responsive and to have proper functioning of the respiratory and cardiovascular systems while at the same time being relieved of severe pain. To allow this to occur, physicians often use a technique called epidural anesthesia. With the patient lying on his or her side, a needle is carefully inserted between the vertebrae into the region immediately surrounding the spinal cord, called the epidural space. Then, a small amount of opiate drug (such as fentanyl or morphine) is injected into the epidural space through a syringe connected to some plastic tubing (Figure 3.6). The opiate drug then binds to mu opiate receptors in the dorsal horn of the spinal cord and inhibits the activity of nerve cells that transmit pain signals to the brain. The injection is usually made in the lower back region where nerve fibers from the pelvic area enter the spinal cord. Because the drug remains confined to this small, localized area within the spinal cord, the patient feels no pain in the pelvic region, yet remains awake, alert, and responsive. When the drug is administered into the epidural space, it does not flow to the rest of the body, so the patient does not experience other side effects of opiates such as nausea and vomiting. Finally, because less of the drug is needed during an epidural than for oral or intravenous administration, it takes less time for the drug to be eliminated from the body. The result is a quicker recovery time.

There are, however, some side effects of epidural anesthesia. The patient's legs often become numb, and movement of the leg muscles is difficult. Other mild side effects include a backache (thought to be a result of over-relaxation of the back muscles), itchiness of the skin, and an inability to urinate. More rarely, patients experience headache, lowered blood

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Figure 3.6 During an epidural, a patient is given a strong anesthetic through an injection into the spinal canal. This allows for pain relief in the lower body (below the point of injection), while the upper body remains unaffected, allowing breathing and heart rate to continue as normal. An epidural is often used to ease the pain of childbirth.

Figure 3.6 During an epidural, a patient is given a strong anesthetic through an injection into the spinal canal. This allows for pain relief in the lower body (below the point of injection), while the upper body remains unaffected, allowing breathing and heart rate to continue as normal. An epidural is often used to ease the pain of childbirth.

pressure, bleeding from the point of needle insertion, and patchy numbness (usually in the legs) that can last for up to three months after the epidural.

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Pregnancy And Childbirth

Pregnancy And Childbirth

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