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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Analgesia and Pain Management01:25

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Opioid Analgesics: Morphine and Other Natural Cogeners01:20

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Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Parenteral Anesthetics: Overview01:24

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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Commonly Used Opioids in the Orthopedic Operating Room: A Narrative Review.

Anvinh Nguyen1, Joseph Donnelly1, Christopher L Robinson2

  • 1Department of Anesthesiology Baylor College of Medicine.

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Summary
This summary is machine-generated.

This review details common opioids used in orthopedic surgery for pain management. It discusses their properties, uses, and risks, emphasizing balanced use in multimodal analgesia strategies.

Keywords:
Orthopedic surgeryenhanced recovery after surgerymultimodal analgesiaopioidsorthopedic anesthesiaperioperative analgesiapostoperative pain management

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Area of Science:

  • Anesthesiology
  • Orthopedic Surgery
  • Pharmacology

Background:

  • Orthopedic surgery causes significant pain, impacting recovery and patient satisfaction.
  • Effective pain management is crucial for early mobilization and reducing complications.
  • Opioids are central to orthopedic perioperative pain management, despite the rise of opioid-sparing protocols.

Purpose of the Study:

  • To review commonly used opioids in orthopedic perioperative care.
  • To analyze pharmacologic properties, indications, dosing, and adverse effects of these opioids.
  • To discuss the role of opioids within multimodal analgesia and risk management.

Main Methods:

  • Narrative review of literature on opioid use in orthopedic surgery.
  • Examination of fentanyl, morphine, remifentanil, hydromorphone, oxycodone, sufentanil, and methadone.
  • Analysis of comparative evidence and adverse event profiles.

Main Results:

  • Detailed pharmacologic profiles and clinical applications of key opioids are presented.
  • Comparative data highlights differences in efficacy and safety for orthopedic pain.
  • The review addresses balancing pain relief with the risks of opioid-induced adverse events.

Conclusions:

  • Opioids remain essential for managing orthopedic surgical pain.
  • Understanding individual opioid characteristics is key for effective perioperative analgesia.
  • Integrating opioids into multimodal strategies is vital for optimizing outcomes and minimizing risks.