Benefits and Risks of Epidural Opioids in the Treatment of Postoperative Pain

  • J. Chrubasik
  • S. Chrubasik
  • E. Martin


Since administration of morphine into the epidural space (Fig. 1) was first introduced in 1979 [9], the method has been increasingly used for the treatment of postoperative pain [34]. Most of the clinically available opioids have been injected into the epidural space. The purpose of this chapter is to review the benefits and risks of various opioids in epidural treatment of postoperative pain, to comment on the safe use of the technique, and to recommend an epidural opioid dose regimen that offers a maximum of advantages with a minimal risk of adverse effects.


Epidural Analgesia Epidural Space Epidural Morphine Epidural Infusion Epidural Fentanyl 
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  1. 1.
    Abboud TK, Moore M, Zhu J, Murakawa K, Minehart M, Longhitano M, Terrasi J, Klepper ID, Choi Y, Kimball S, Chu G (1987) Epidural butorphanol or morphine for the relief of post-cesarean section pain: ventilatory responses to carbon-dioxide. Anesth Analg 66: 887–893PubMedGoogle Scholar
  2. 2.
    Ackerman WE, Juneja MM, Kaczorowski DM, Colclough GW (1989) A comparison of the incidence of pruritus following epidural opioid administration in the parturient. Can J Anaesth 36: 388–391PubMedGoogle Scholar
  3. 3.
    Andrews CJH, Robertson JA, Chapman JM (1985) Postoperative analgesia with intravenous infusion of alfentanil. Lancet II: 671Google Scholar
  4. 4.
    Atweh SF, Kuhar MJ (1977) Autoradiographic localization of opiate receptors in rat brain. I. Spinal cord and lower medulla. Brain Res 124: 53–67PubMedGoogle Scholar
  5. 5.
    Badner NH, Sandler AN, Koren G, Lawson SL, Klein J, Einarson TR (1990) Lumbar epidural fentanyl infusions postthoracotomy patients: analgesic, respiratory, and pharmacokinetic effects. J Cardiothorac Anesth 4: 543–551PubMedGoogle Scholar
  6. 6.
    Bailey PL, Clark NJ, Pace NL, Isern M, Stanley TH (1986) Failure of nalbuphine to antagonize morphine: a double-blind comparison with naloxone. Anesth Analg 65: 605–611PubMedGoogle Scholar
  7. 7.
    Baxter AD, Laganiere S, McGilveray IJ, Hull K (1991) A dose-response study of nalbuphine for postthoracotomy epidural analgesia. Can J Anaesth 38: 175–182PubMedGoogle Scholar
  8. 8.
    Beaver WT, Feise GA (1978) A comparison of the analgesic effect of intramuscular nalbuphine and morphine in patients with postoperative pain. J Pharmacol Exp Ther 204: 487–496PubMedGoogle Scholar
  9. 9.
    Behar M, Magora F, Olshwang D, Davidson JT (1979) Epidural morphine in treatment of pain. Lancet 1: 527–529PubMedGoogle Scholar
  10. 10.
    Benzon HT (1984) Intracerebral hemorrhage after dural puncture and epidural blood patch: nonpostural and noncontinuous headache. Anesthesiology 60: 258–259PubMedGoogle Scholar
  11. 11.
    Boas RA, Villiger JW (1985) Clinical actions of fentanyl and buprenorphine. The significance of receptor binding. Br J Anaesth 57: 192–196PubMedGoogle Scholar
  12. 12.
    Boersma FP, Ten Kate A, Noorduin H, Pieters W, Woestenborghs R, Vanden Bussche G (1991) Sufentanil concentrations in CSF, plasma and human spinal cord after long term epidural infusion. Eur J Anaesthesiol 8: 338–339Google Scholar
  13. 13.
    Bowdle TA, Greichen SL, Bjurstrom RL, Schoene RB (1987) Butorphanol improves CO2 response and ventilation after fentanyl anesthesia. Anesth Analg 66: 517–522PubMedGoogle Scholar
  14. 14.
    Brockway MS, Noble DW, Sharwood-Smith GH, McClure JH (1990) Profound respiratory depression after extradural fentanyl. Br J Anaesth 64: 243–245PubMedGoogle Scholar
  15. 15.
    Bromage PR (1978) Epidural analgesia. Saunders, Philadelphia, pp 654–715Google Scholar
  16. 16.
    Bromage PR, Camporesi E, Chestnut D (1980) Epidural narcotics for postoperative analgesia. Anesth Analg 59: 473–480PubMedGoogle Scholar
  17. 17.
    Brownridge P, Frewin DB (1985) A comparative study of techniques of postoperative analgesia following caesarean section and lower abdominal surgery. Anaesth Intensive Care 13: 123–130PubMedGoogle Scholar
  18. 18.
    Camann WR, Hurley RH, Gilbertson LI, Long ML, Datta S (1991) Epidural nalbuphine for analgesia following caesarean delivery: dose-response and effect of local anaesthetic choice. Can J Anaesth 38: 728–732PubMedGoogle Scholar
  19. 19.
    Camann WR, Loferski BL, Fanciullo GJ, Stone ML, Datta S (1992) Does epidural administration of butorphanol offer any clinical advantage over the intravenous route? Anesthesiology 76: 216–220PubMedGoogle Scholar
  20. 20.
    Camu F, Debucquoy F (1991) Alfentanil infusion for postoperative pan: a comparison of epidural and intravenous routes. Anesthesiology 75: 171–178PubMedGoogle Scholar
  21. 21.
    Chisholm RH, Fleischl J (1990) Respiratory arrest with epidural fentanyl. Anaesth Intensive Care 18: 423PubMedGoogle Scholar
  22. 22.
    Chrubasik J (1984) Epidural, on-demand, low-dose morphine infusion for postoperative pain. Lancet 1: 107–108PubMedGoogle Scholar
  23. 23.
    Chrubasik J, Vogel W, Friedrich G (1984) Morphinkonzentrationen im Serum unter bedarfsgesteuerter periduraler Morphininfusion. Anaesth Intensivther Notfallmed 19: 231–234Google Scholar
  24. 24.
    Chrubasik J, Wiemers K (1985a) Kein analgetischer Wirkverlust. Anaesth Intensivther Notfallmed 20: 19–21Google Scholar
  25. 25.
    Chrubasik J, Wiemers K (1985b) Continuous-plus-on-demand epidural infusion of morphine for postoperative pain relief by means of a small, externally worn infusion device. Anesthesiology 62: 263–267PubMedGoogle Scholar
  26. 26.
    Chrubasik J, Scholler KL, Wiemers K, Friedrich G, Weigel K, Roth H, Berg S (1985) Zum EinfluB des Volumens periduraler Morphininj ektionen auf die Morphinkonzentration in der Zisterna magna des Hundes. Anaesthesist 34: 304–308PubMedGoogle Scholar
  27. 27.
    Chrubasik J, Vogel W, Tröschler H, Farthmann EH (1987) Continuous-plus-on-demand epidural infusion of buprenorphine versus morphine in postoperative treatment of pain. Drug Res 37: 361–363Google Scholar
  28. 28.
    Chrubasik J, Wüst H, Schulte-Mönting J, Thon K, Zindler M (1988a) Relative analgesic potency of epidural fentanyl, alfentanil and morphine in treatment of postoperative pain. Anesthesiology 68: 929–933PubMedGoogle Scholar
  29. 29.
    Chrubasik J, Warth L, Wüst H, Bretschneider H, Schulte-Mönting J, Röher HD, Zindler M (1988b) Untersuchungen zur analgetischen Wirksamkeit peridural applizierten Tramadols bei der Behandlung von Schmerzen nach abdominal-chirurgischen Eingriffen. Schmerz/Pain/Douleur 9: 12–18Google Scholar
  30. 30.
    Chrubasik J, Magora F (1990) Relative epidural analgesic potencies of opiates in treatment of postoperative pain. Anest Anal g 70: S60Google Scholar
  31. 31.
    Chrubasik J, Chrubasik S, Martin E (1993) The ideal epidural opioid-fact or fantasy. Eur J Anaesth 10: 79–100Google Scholar
  32. 32.
    Cohen SE, Tan S, White PF (1988) Sufentanil analgesia following cesarean section: epidural versus intravenous administration. Anesthesiology 68: 129–134PubMedGoogle Scholar
  33. 33.
    Cohen S, Amar D, Pantuck CB, Pantuck EJ, Weissman AM, Landa S, Singer N (1992) Epidural patient-controlled analgesia after cesarean section: buprenorphine-0.015% bupivacaine with epinephrine versus fentanyl-0.015% bupivacaine with and without epinephrine. Anesth Analg 74: 226–230PubMedGoogle Scholar
  34. 34.
    Cousins MJ, Mather LE (1984) Intrathecal and epidural administration of opioids. Anesthsiology 61: 276–310Google Scholar
  35. 35.
    Cousins MJ (1987) Comparative pharmacokinetics of spinal opioids in humans: a step toward determination of relative safety. Anesthesiology 67: 875–876PubMedGoogle Scholar
  36. 36.
    De Sousa H, Stiller R (1989) Cisternal CSF and arterial plasma levels of fentanyl, alfentanil and sufentanil after lumbar epidural injection. Anesthesiology 71: A839Google Scholar
  37. 37.
    Dobkin AB, Eamakaow S, Zak S, Caruso FS (1974) Butorphanol: a double-blinde evaluation in postoperative patients with moderate or severe pain. Can Anaesth Soc J 21: 600–610PubMedGoogle Scholar
  38. 38.
    Donadoni R, Rolly G, Noorduin H, Van den Bussche G (1985) Epidural sufentanil for postoperative pain relief. Anaesthesia 40: 634–638PubMedGoogle Scholar
  39. 39.
    Drenger B, Magora F, Evron S, Caine M (1986) The action of intrathecal morphine and methadone on the lower urinary tract in the dog. J Urol 135: 852–855PubMedGoogle Scholar
  40. 40.
    Drenger B, Magora F (1989) Urodynamic studies after intrathecal fentanyl and buprenorphine in the dog. Anesth Analg 69: 348–353PubMedGoogle Scholar
  41. 41.
    Drenger B, Sughayer H, Chrubasik J, Goldofsky S, Magora F (1993) Urodynamic and pharmacokinetics of intrathecal alfentanil in canine. Anesth Analg 76: 786–790PubMedGoogle Scholar
  42. 42.
    Eimerl D, Magora F, Shir Y, Chrubasik J (1986) Patient-controlled analgesia with epidural methadone by means of an external infusion pump. Schmerz/Pain/Douleur 7: 156–160Google Scholar
  43. 43.
    Etches RC, Sandler AN, Lawson SL (1991) A comparison of the analgesic and respiratory effects of epidural nalbuphine or morphine in postthoracotomy patients. Anesthesiology 75: 9–14PubMedGoogle Scholar
  44. 44.
    Fee JPH, Brady MM, Furness G, Chambers M, Clarke RSJ (1989) Analgesia after hip replacement surgery: comparison of nalbuphine with morphine. Br J Anaesth 63: 756–758PubMedGoogle Scholar
  45. 45.
    Fish DJ, Rosen SM (1990) Epidural opioids as a cause of vertical nystagmus. Anesthesiology 73: 785–786PubMedGoogle Scholar
  46. 46.
    Friedrich G, Chrubasik J, Scholler KL, Andreas P, Rupp HP, Weigel K, Roth H (1985) Peridurale Morphinapplikation: Zum Risiko der Atemdepression. Schmerz/ Pain/Douleur 6: 10–12Google Scholar
  47. 47.
    Gal TJ, DiFazio CA, Moscicki J (1982) Analgesic and respiratory activity of nalbuphine: a comparison with morphine. Anesthesiology 57: 367–374PubMedGoogle Scholar
  48. 48.
    Galloway FM, Hrdlicka J, Losada M, Noveck RJ, Caruso FS (1977) Comparison of analgesia by intravenous butorphanol and meperidine in patients with post-operative pain. Can Anaesth Soc J 24: 90–102PubMedGoogle Scholar
  49. 49.
    Geller E, Chrubasik J, Graf R, Chrubasik S, Schulte-Mönting J (1993) A randomized double blind comparison of epidural sufentanil vs intravenous sufentanil or epidural fentanyl analgesia after major abdominal surgery. Anesth Analg 76: 1243–1250PubMedGoogle Scholar
  50. 50.
    Gilbert MS, Hanover RM, Moylan DS, Caruso FS (1976) Intramuscular butorphanol and meperidine in postoperative pain. Clin Pharmacol Ther 20: 359–364PubMedGoogle Scholar
  51. 51.
    Glass PSA, Estok P, Ginsberg B, Goldberg JS, Sladen RN (1992) Use of patient-controlled analgesia to compare the efficacy of epidural to intravenous fentanyl administration. Anesth Analg 74: 345–351PubMedGoogle Scholar
  52. 52.
    Goundrey J (1990) Vertigo after epidural morphine. Can J Anaesth 37: 804–905PubMedGoogle Scholar
  53. 53.
    Gourlay GK, Cherry DA, Cousins MJ (1985) Cephalad migration of morphine in CSF following lumbar epidural administration in patients with cancer pain. Pain 23: 317–326PubMedGoogle Scholar
  54. 54.
    Gourlay GK, Willis RJ, Lamberty J (1986) A double-blind comparison of the efficacy of methadone and morphine in postoperative pain control. Anesthesiology 64: 322–327PubMedGoogle Scholar
  55. 55.
    Gourlay GK, Cherry DA, Plummer JL, Armstrong PJ, Cousins MJ (1987) The influence of drug polarity on the absorption of opioid drugs into CSF and subsequent cephalad migration following lumbar epidural administration: application to morphine and pethidine. Pain 31: 297–305PubMedGoogle Scholar
  56. 56.
    Gourlay GK, Kowalski SR, Plummer JL, Cousins MJ, Armstrong PJ (1988) Fentanyl blood concentration — analgesic response relationship in the treatment of postoperative pain. Anesth Analg 67: 329–337PubMedGoogle Scholar
  57. 57.
    Gourlay GK, Murphy TM, Plummer JL, Kowalski SR, Cherry DA, Cousins MJ (1989) Pharmacokinetics of fentanyl in lumbar and cerival CSF following lumbar epidural and intravenous administration. Pain 38: 253–259PubMedGoogle Scholar
  58. 58.
    Grant RP, Dolman JF, Harper JA, White SA, Parsons DG, Evans KG, Merrick CP (1992) Patient-controlled lumbar epidural fentanyl compared with patient-controlled intravenous fentanyl for postthoracotomy pain. Can J Anaesth 39: 214–219PubMedGoogle Scholar
  59. 59.
    Guinard JP, Mavrocordatos P, Chiolero R, Carpenter RL (1992) A randomized comparison of intravenous versus lumbar and thoracic epidural fentanyl for analgesia after thoracotomy. Anesthesiology 77: 1108–1115PubMedGoogle Scholar
  60. 60.
    Gustafsson LL, Schildt B, Jacobsen K (1982) Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden. Br J Anaesth 54: 479–486PubMedGoogle Scholar
  61. 61.
    Harrison DM, Sinatra R, Morgese L, Chung JH (1988) Epidural narcotic and patient-controlled analgesia for post-cesarean section pain relief. Anesthesiology 68: 454–457PubMedGoogle Scholar
  62. 62.
    Heel RC, Brogden RN, Speight TM, Avery GS (1978) Butorphanol: a review of its pharmacological properties and therapeutic efficacy. Drugs 16: 473–505PubMedGoogle Scholar
  63. 63.
    Inagaki Y, Mashimo T, Yoshiya I (1992) Segmental analgesic effect and reduction of halothane MAC from epidural fentanyl in humans. Anesth Analg 74: 856–864PubMedGoogle Scholar
  64. 64.
    Jaffe RS, Moldenhauer CC, Hug CC, Finlayson DC, Tobia V, Kopel ME (1988) Nalbuphine antagonism of fentanyl-induced ventilatory depression: a randomized trial. Anesthesiology 68: 254–260PubMedGoogle Scholar
  65. 65.
    Jasinski DR, Mansky PA (1972) Evaluation of nalbuphine for abuse potential. Clin Pharm Ther 13: 78–90Google Scholar
  66. 66.
    Jensen FM, Madsen JB, Guldager H, Christensen A, Eriksen HO (1984) Respiratory depression after epidural morphine in the postoperative period. Influence of posture. Acta Anaesthesiol Scand 28: 600–602Google Scholar
  67. 67.
    Kenepp NB, Gutsche BB (1981) Inadvertent intravascular injections during lumbar epidural anesthesia. Anesthesiology 54: 172–173PubMedGoogle Scholar
  68. 68.
    Kilpatrick ME, Girgis NI (1983) Meningitis-a complication of spinal anesthesia. Anesth Analg 62: 513–515PubMedGoogle Scholar
  69. 69.
    Klement W, Rothe G, Peters J (1991) Paraplegie nach Entfernung eines Epiduralkatheters. Reg Anaesth 14: 88–91PubMedGoogle Scholar
  70. 70.
    Klepper ID, Rosen M, Vickers MD, Mapleson WW (1986) Respiratory function following nalbuphine and morphine in anaesthetized man. Br J Anaesth 58: 625–629PubMedGoogle Scholar
  71. 71.
    Kunz U, Panning B, Stolke D (1989) Chronisches Subduralhämatom nach einer Spinalanaesthesie. Reg Anaesth 12: 34–37PubMedGoogle Scholar
  72. 72.
    Lanz E, Theiss D, Riess W, Sommer U (1982) Epidural morphine for postoperative analgesia: a double-blind study. Anesth Analg 61: 236–240PubMedGoogle Scholar
  73. 73.
    Lanz E, Kehrberger E, Theiss D (1985) Epidural morphine. Anest Analg 64: 786–791Google Scholar
  74. 74.
    Lawhorn CD, McNitt JD, Fibuch EE, Joyce JT, Leadley RJ (1991) Epidural morphine with butorphanol for postoperative analgesia after cesarean delivery. Anesth Analg 72: 53–57PubMedGoogle Scholar
  75. 75.
    Leander JD (1983) Evidence that nalorphine, butorphanol and oxilorphan are partial agonists at kappa-opioid receptor Eur J Pharmacol 86: 467–470Google Scholar
  76. 76.
    Lehmann KA, Gördes B (1988) Postoperative On-demand Analgesie mit Buprenorphin. Anaesthesist 37: 65–70PubMedGoogle Scholar
  77. 77.
    Lehmann KA, Reichling U, Wirtz R (1988) Influence of naloxone on the postoperative analgesic and respiratory effects of buprenorphine. Eur J Pharmacol 34: 343–352Google Scholar
  78. 78.
    Lehmann KA, Abu-Shibika M, Horrichs-Haermeyer G (1990a) Postoperative Schmerztherapie mit L-Methadone and Metamizol. Anaesth Intensivther Notfallmed 25: 152–159Google Scholar
  79. 79.
    Lehmann KA, Kratzenberg U, Schroeder-Bark B, Horrichs-Haermeyer G (1990b) Postoperative patient controlled analgesia with tramadol. Analgesic efficacy and minimum effective concentrations. Clin J Pain 6: 212–220PubMedGoogle Scholar
  80. 80.
    Lehmann KA, Gerhard A, Horrichs-Haermeyer G, Grond S, Zech D (1991) Post-operative patient-controlled analgesia with sufentanil. Analgesic efficacy and minimum effective concentrations. Acta Anaesthesiol Scand 35: 221–226PubMedGoogle Scholar
  81. 81.
    Lema MJ, Reiestad R (1989) A comparison of epidural alfentanil, morphine and alfentanilmorphine combinations for postoperative analgesia after total hip replacement ( THR ). Anesthesiology 71: A702Google Scholar
  82. 82.
    Loper KA, Ready LB, Downey M, Sandler AN, Nessly M, Rapp S, Badner N (1990) Epidural and intravenous fentanyl infusions are clinically equivalent after knee surgery. Anesth Analg 70: 72–75PubMedGoogle Scholar
  83. 83.
    Lubenow T, Keh-Wong E, Kristof K, Ivankovich O, Ivankovich AD (1988) Inadvertent subdural injection: a complication of an epidural block. Anesth Analg 67: 175–179PubMedGoogle Scholar
  84. 84.
    Lubenow T, Durrani Z, Ivankovich A (1990) Evaluation of continuous epidural fentanyl/butorphanol infusion for postoperative pain. Anesthesiology 73: A800Google Scholar
  85. 85.
    MacEvilly M, O’Carroll C (1989) Hallucinations after epidural buprenorphine BMJ 298: 928–929PubMedGoogle Scholar
  86. 86.
    Magora F, Chrubasik J, Damm D, Schulte-Mönting J, Shir Y (1987) Application of a new method for measurement of plasma methadone levels to the use of epidural methadone for relief of postoperative pain. Anesth Analg 66: 1308–1311PubMedGoogle Scholar
  87. 87.
    Martegani G, Varesio V, Agosta I (1987) Segnalazione di un caso di depressione respiratoria riferibile all’impiego di boprenorfina per via peridurale. Min Anest 53: 141–143Google Scholar
  88. 88.
    Maunuksela LE, Korpela R, Olkkola KT (1988) Double-blind, multiple-dose comparison of buprenorphine and morphine in postoperative pain of children. Br J Anaesth 60: 48–55PubMedGoogle Scholar
  89. 89.
    Maurette P, Tauzin-Fin P, Vincon G, Brachet-Lierman A (1989) Arterial and ventricular CSF pharmacokinets after intrathecal meperidine in humans. Anesthesiology 70: 961–966PubMedGoogle Scholar
  90. 90.
    Metzger G, Singbartl G (1991) Spinal epidural hematoma following epidural anesthesia versus spontaneous spinal subdural hematoma. Two case reports. Acta Anaesthesiol Scand 35: 105–107PubMedGoogle Scholar
  91. 91.
    Millan MJ (1989) Kappa-opioid receptor mediated antinociception in the rat. I. Comparative actions of mu and kappa opioids against noxious thermal, pressure and electrical stimuli. J Pharmacol Exp Ther 251: 334–341PubMedGoogle Scholar
  92. 92.
    Mok MS, Tsai YJ, Ho WM, Tso HS, Lippmann M (1986) Efficacy of epidural butorphanol compared to morphine for the relief of postoperative pain. Anesthesiology 65: A175Google Scholar
  93. 93.
    Morando R, Sinatra RS, Fu ES, Collins JG (1987) Failure of intrathecally administered nalbuphine to suppress visceral pain in pregnant rats. Anesthesiology 67: A447Google Scholar
  94. 94.
    Noble DW, Morrison LM, Brockway MS, McClure JH (1991) Adrenaline fentanyl or adrenaline and fentanyl as adjuncts to bupivacaine for extradural anaesthesia in elective caesarean section. Br J Anaesth 66: 645–650PubMedGoogle Scholar
  95. 95.
    Owen H, Currie JC, Plummer JL (1991) Variation in the blood concentration/analgesic response relationship during patient-controlled analgesic with alfentanil. Anaesth Intens Care 9: 555–560Google Scholar
  96. 96.
    Palacios QT, Jones MM, Hawkins JL, Adenwala JN, Longmire S, Hess KR, Skjonsby BS, Morrow DH, Joyce TH (1991) Post-Caesarean section analgesia: a comparison of epidural butorphanol and morphine. Can J Anaesth 38: 24–30PubMedGoogle Scholar
  97. 97.
    Parker EO, Brookshire GL, Bartel SJ, Menard RG, Culverhouse ED, Ault LC (1985) Effects of epinephrine on epidural fentanyl, sufentanil and hydromorphone for postoperative analgesia. Anesthesiology 63: A235Google Scholar
  98. 98.
    Petty R, Stevens R, Hill H, Hahn M, Kao T (1991) Does epidural sufentanil spread rostrally in the spinal axis? Anesthesiology 75: A744Google Scholar
  99. 99.
    Picker MJ, Negus SS, Craft RM (1990) Butorphanol’s efficacy at mu and kappa opioid receptors: inferences based on the schedule-controlled behavior of nontolerant and morphine-tolerant rats and on the responding of rats under a drug discrimination procedure. Pharmacol Biochem Behav 36: 563–568PubMedGoogle Scholar
  100. 100.
    Preston KL, Bigelow GE, Liebson IA (1988) Butorphanol-precipitated withdrawal in opioid-dependent human volunteers. J Pharmacol Exp Ther 246: 441–448PubMedGoogle Scholar
  101. 101.
    Rawal N, Möllefors K, Axelsson K, Lindgardh G, Widman B (1983) An experimental study of urodynamic effects of epidural morphine and of naloxone reversal. Anesth Analg 62: 641–647PubMedGoogle Scholar
  102. 102.
    Ready LB, Helfer D (1989) Bacterial meningitis in parturients after epidural anesthesia. Anesthesiology 71: 988–990PubMedGoogle Scholar
  103. 103.
    Ready LB, Edwards WT (1992) Management of acute pain: a practical guide. IASP Publications, SeattleGoogle Scholar
  104. 104.
    Rein P, Brothers W, Eakins K, Cooper K, Dunwiddie WC (1985) Respiratory depressant effects of epidural butorphanol. Anesthesiology 63: A247Google Scholar
  105. 105.
    Reynolds F, Speedy HM (1990) The subdural space: the third place to go astray. Anaesthesia 45: 120–123PubMedGoogle Scholar
  106. 106.
    Rudehill A, Gordon E, Rahn T (1983) Subdural haematoma. A rare but lifethreatening complication after spinal anaesthesia. Acta Anaestesiol Scand 27: 376–377Google Scholar
  107. 107.
    Saady A (1976) Epidural abscess complicating thoracic epidural analgesia. Anesthesiology 44: 244–246PubMedGoogle Scholar
  108. 108.
    Saberski LR, Schartz JI, Greenhouse BB, Kennedy TM, Ullman DA (1988) A unique complication of a lumbar epidural catheter. Anesthesiology 69: 634–635PubMedGoogle Scholar
  109. 109.
    Salomäki TE, Laitinen JO, Nuutinen LS (1991) A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy. Anesthesiology 75: 790–795PubMedGoogle Scholar
  110. 110.
    Sandler AN, Stringer D, Panos L, Badner N, Friedlander M, Koren G, Katz J, Klein J (1992) A randomized, double-blind comparison of lumbar epidural and intravenous fentanyl infusion for postthoracotomy pain relief. Anesthesiology 77: 626–634PubMedGoogle Scholar
  111. 111.
    Schmauss C, Doherty C, Yaksh TL (1983) The analgetic effects of an intrathecally administered partial opiate agonist, nalbuphine hydrochloride. Eur J Pharmacol 86: 1–7Google Scholar
  112. 112.
    Scott EW, Cazenave CR, Virapongse C (1989) Spinal subarachnoid hematoma complicating lumbar puncture: diagnosis and management. Neurosurgery 25: 287–292PubMedGoogle Scholar
  113. 113.
    Sidhu MS, Asrani RV, Bassell GM (1983) An unusual complication of extradural catheterization in obstetric anaesthesia. Br J Anaesth 55: 473–475PubMedGoogle Scholar
  114. 114.
    Sinatra RS, Lodge K, Sibert K, Chung KS, Chung JH, Parker A, Harrison DM (1989) A comparison of morphine, meperidine, and oxymorphone as utilized in patient-controlled analgesia following cesarean delivery. Anesthesiology 70: 585–590PubMedGoogle Scholar
  115. 115.
    Sjöström S, Hartvig P, Persson MP, Tamsen A (1987) Pharmacokinetics of epidural morphine and meperidine in humans. Anesthesiology 67: 877–888PubMedGoogle Scholar
  116. 116.
    Sjöström S, Hartvig D, Tamsen A (1988) Patient-controlled analgesia with extradural morphine or pethidine. Br J Anaesth 60: 358–366PubMedGoogle Scholar
  117. 117.
    Steinstra R, Van Poorten F (1989) Immediate respiratory arrest after caudal epidural sufentanil. Anesthesiology 71: 993–994PubMedGoogle Scholar
  118. 118.
    Swerdlow M (1982) Medico-legal aspects of complications following pain relieving blocks. Pain 13: 321–331PubMedGoogle Scholar
  119. 119.
    Tamsen A, Hartvig P, Fagerlund C, Dahlström B, Bondesson U (1982) Patient-controlled analgesic therapy: clinical experience. Acta Anaesth Scand 74: 157–160Google Scholar
  120. 120.
    Tanaka M, Watanabe S, Naito H (1992) Optimal dose combination of epidural morphine and fentanyl for postoperative analgesia: a double-blind study. Anesthesiology 77: A831Google Scholar
  121. 121.
    Tavakoli M, Corssen G, Caruso FS (1976) Butorphanol and morphine: a doubleblind comparison of their parenteral analgesic activity. Anesth Analg 55: 394–401PubMedGoogle Scholar
  122. 122.
    Thörn SE, Wattwil M, Näslund I (1992) Postoperative epidural morphine, but not epidural bupivacaine, delays gastric emptying on the first day after cholecystectomy Reg Anesth 17: 91–94PubMedGoogle Scholar
  123. 123.
    Vercauteren M, Meert T, D’Hooghe RD, Boersma F, Melis W (1992) Spinal sufentanil in rats. part III: effect of diluent volume on epidural sufentanil. Acta Anaesth Scand 36: 305–306PubMedGoogle Scholar
  124. 124.
    Vickers MD, O’Flaherty D, Szekely SM, Read M, Yoshizumi J (1992) Tramadol: pain relief by an opioid without depression of respiration. Anaesthesia 47: 291–296PubMedGoogle Scholar
  125. 125.
    Wang JJ, Mok MS, Lippmann M (1988) Comparative analgesic efficacy of epidural nalbuphine, butorphanol, meperidine and morphine. Anest Analg 67: S248Google Scholar
  126. 126.
    Wang JJ, Mok MS, Lippman M (1989) Analgesic effect of epidural morphine and nalbuphine in combined use. Anesthesiology 71: A703Google Scholar
  127. 127.
    Wang CY (1992) Respiratory depression after extradural fentanyl. Br J Anaesth 69: 544PubMedGoogle Scholar
  128. 128.
    Wang JM, Denson D, Knarr DC, Raj PP (1992) Continous epidural methadone for the management of postoperative pain after lower abdominal surgery. Reg Anesth 17: 26–28PubMedGoogle Scholar
  129. 129.
    Weddel DJ, Mulroy MF (1983) Hemiparesis following dural puncture Anesthesiology 59: 475–477Google Scholar
  130. 130.
    Weightman WM (1991) Respiratory arrest during epidural infusion of bupivacaine and fentanyl. Anaesth Intens Care 19: 282–284Google Scholar
  131. 131.
    Weintraub SJ, Naulty JS (1985) Acute abstinence syndrome after epidural injection of butorphanol. Anest Analg 64: 452–453Google Scholar
  132. 132.
    Welch DB, Hrynaszkiewicz A (1981) Postoperative analgesia using epidural methadone. Administration by the lumbar route for thoracic pain relief. Anaesthesia 36: 1051–1054PubMedGoogle Scholar
  133. 133.
    Welchew EA, Hosking J (1985) Patient-controlled postoperative analgesia with alfentanil. Anaesthesia 40: 1172–1177PubMedGoogle Scholar
  134. 134.
    Welchew EA, Breen DP (1991) Patient-controlled on demand epidural fentanyl. Anaesthesia 46: 438–441PubMedGoogle Scholar
  135. 135.
    Wells DA, Davies G (1987) Profound central nervous system depression from epidural fentanyl for extracorporeal shock wave lithotripsy. Anesthesiology 67: 991–992PubMedGoogle Scholar
  136. 136.
    Wolff AP, Hasenbos MA, Liem TH, Gielen MJ (1992) Accidental overdose of epidural bupivacaine and sufentanil. Reg Anesth 17: 237–238PubMedGoogle Scholar
  137. 137.
    Writer WDR, Hurtig JB, Evans D, Needs RE, Hope CE, Forrest JB (1985) Epidural morphine prophylaxis of postoperative pain: report of a double-blind multicentre study. Can J Anaesth Soc J 32: 330–334Google Scholar
  138. 138.
    Yarnell RW, Polis T, Reid GN, Murphy IL, Penning JP (1992) Patient-controlled analgesia with epidural meperidine after elective cesarean section. Regional Anesthesia 17: 329–333PubMedGoogle Scholar
  139. 139.
    Zaren B, Hartvig P, Tamsen A (1984) Patient-controlled analgesics therapy with epidural pethidine for postoperative pain relief. In: Wüst JH, Stanton Hicks M, Zindler M (eds.) Neue Aspekte in der Regionalanästhesie. Springer, Berlin Heidelberg New York, pp 173–176Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • J. Chrubasik
  • S. Chrubasik
  • E. Martin

There are no affiliations available

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