Chapter 32 Intra-Articular and Intraperitoneal Opioids for Postoperative Pain

Question 2

intra-articular NSAIDs

Answer 2

NSAIDs have consistently demonstrated a benefit in modulating postoperative
pain when injected IA, yet there is a concern that
they may inhibit or retard bone healing

Question 3

intra-articular Clonidine

Answer 3

use of the alpha-2 agonist clonidine IA has demonstrated a modest and limited reduction in postoperative pain, although the same controversy exists as to whether these benefits are
mediated systemically or are local phenomena

Question 4

The effects of IA opioids may be mediated through

Answer 4

the G-protein–coupled receptors affecting the cAMP pathway. Stimulation of chondrocytes with beta-endorphin resulted in decreased phosphorylation of
the transcription factor cAMP responsive element binding
protein (CREB), an effect reversible by naloxone

Question 5

Benefit of IA morphine added as a component of multimodal analgesia following arthroscopic ankle surgery

Answer 5

there was a significant reduction in pain, joint swelling, time of immobilization, duration of sick leave, and return to physical activity.

Question 6

Meperidine

Answer 6

synthetic opioid agonist at m- and k-opioid receptors derived from phenylepiperidine

Question 7

Structurally, meperidine
is similar to

Answer 7

atropine, and it possesses a mild atropine-like
antispasmodic effect.

Question 8

Meperidine vs. Morphine

Answer 8

It is about one-tenth as potent as morphine and its duration of pharmacologic action is
about 2 to 4 hr.

Question 9

IA Meperidine

Answer 9

Meperidine has been injected IA in doses of 10 to 200 mg, alone or in combination with local anesthetics and tenoxicam.

Question 10

Fentanyl vs. Morphine

Answer 10

fentanyl is about 75 to 100 times more potent than morphine. A single dose of fentanyl administered intravenously has a more rapid onset than morphine and a
shorter duration of clinical effect, although the elimination
half-life is longer than that of morphine.

Question 11

IA Fentanyl

Answer 11

IA bupivacaine was noted to provide superior analgesia
compared to IA fentanyl in the immediate postoperative
period, for up to 2 hr, following knee arthroscopy

Question 12

Sufentanil vs Fentanyl

Answer 12

sufentanil has a greater affinity for opioid receptors than fentanyl,and is about 12 times as potent. Sufentanil is extensively protein bound (92.5% vs. fentanyl at 79% to 87%) and is highly lipid soluble. Its elimination half-life is intermediate between that of fentanyl and alfentanil

Question 13

IA Sufentanil and Fentanyl

Answer 13

conclusion, IA fentanyl analgesia in doses up to 100 mg
or sufentanil up to 10 mg both appear to be modestly
successful in modulating nociception after knee arthroscopy.

Question 14

Tramadol

Answer 14

Tramadol is a synthetic narcotic with a weak mu-receptor
agonist activity. It also enhances the function of the spinal
descending inhibitory pathway by inhibition of reuptake
of both 5-hydroxytryptamine (5-HT) and norepinephrine
and stimulate the presynaptic release of 5-HT

Question 15

IA tramadol

Answer 15

IA tramadol 100 mg appears to
have analgesic effects after knee arthroscopies and medial
meniscectomies.

Question 16

order of IP (intraperitoneally) potencies

Answer 16

remifentanil > alfentanil > morphine, while
the duration of analgesia was morphine > > alfentanil >
remifentanil

Question 17

side effect profiles were best with

Answer 17

morphine
> alfentanil > remifentanil

Question 18

clinical significance
of these finding of INTRAPERITONEAL OPIOID

Answer 18

The clinical significance
of these findings may be simply that the highly
lipid-soluble agents are potent analgesics when administered
IP, but are also associated with greater risk

Question 19

IP opioids have been used following

Answer 19

laparoscopic cholecystectomy,
laparoscopic gynecologic surgery, and after open intra-abdominal procedures.