The Options for Neuraxial Drug Administration

Area of Science:

• Anesthesiology
• Pharmacology
• Pain Management

Background:

• Neuraxial drug administration, including epidural and intrathecal injections, has been utilized for over a century.
• It remains a cornerstone in modern anesthesiology and both acute and chronic pain therapy.
• Numerous drugs are employed, but not all have official approval for neuraxial use, necessitating a deep pharmacological understanding.

Purpose of the Study:

• To provide a comprehensive review of neuraxial drug administration.
• To cover relevant anatomy, general pharmacology, pharmacokinetics, pharmacodynamics, and clinical applications.
• To discuss neurotoxicity and properties of commonly used drugs for safe and effective patient care.

Main Methods:

• Narrative review of current scientific knowledge.
• Summarization of neuraxial anatomy, including pediatric considerations.
• Delineation of general pharmacology, pharmacokinetics, and pharmacodynamics specific to epidural and intrathecal administration.

Main Results:

• Detailed review of clinical indications: perioperative care, obstetrics, and chronic pain management.
• Discussion of potential neurotoxic effects associated with neuraxial drugs.
• Specific properties of commonly used neuraxial drugs are highlighted for clinical relevance.

Conclusions:

• A thorough grasp of neuraxial drug pharmacology is essential for safe and efficient clinical practice.
• This review synthesizes key information on anatomy, pharmacology, indications, and safety of neuraxial drug administration.
• An overview of emerging developments in neuraxial drug therapy is provided.