Schmerler- N615 - Regional Anesthesia Adjuncts

Front 1

Regional Adjuncts

Back 1

- use to supplement effects of LA
- dece overall LA dose requirement
- 2000: incr use due to decr lidocaine use for spinal
- can be used for peripheral blocks, esp ambulatory surgery

Front 2

What are the most common adjuncts used in neuraxial blocks?

Back 2

opioids and alpha 2 agonists

Front 3

Benefits of opioid adjuncts

Back 3

pain relief
few clinically significant side effects

Front 4

What types of adjunct opioids are used

Back 4

fentanyl
sufentanil
preservative free morphine sulfate

Front 5

Where can adjuncts be administered?

Back 5

intrathecal
epidural
peripheral

Front 6

What alpha 2 agonists can be used as adjuncts?

Back 6

clonidine
dexmedetomidine

Front 7

What is the other name for preservative free morphine?

Back 7

duramorph

Front 8

What are the 3 primary side effects of neuraxial opiates?

Back 8

1. pruritis
2. N/V
3. resp depr

Front 9

What does it mean if a spinal anesthetic is BIPHASIC?

Back 9

concern about second episode of resp depression 12-16 hrs after first dose

Front 10

What is the range of dose indicated for intrathecal PF morphine

Back 10

0.1-0.2 mg

Front 11

What is the optimal dose of PF morphine intrathecal for elderly pts?

Back 11

0.1 mg

Front 12

What is the problem with incr doses of PF morphine?

Back 12

incr side effect profile

Front 13

Why is morphine better than sufentanil in spinals?

Back 13

lasts much longer (20 hrs as opposed to 6 hrs with sufentanil) even though onset slightly slower

Front 14

Intrathecal _____ is associated with higher side effect profile as compared to other conventional opioids.

Back 14

morphine

Front 15

No benefit is shown with intrathecal morphine doses greater than ____ in terms of analgesic efficacy.

Back 15

0.3 mg

Front 16

What is the only intrathecal opiate that has been officially approved by the FDA for intrathecal use?

Back 16

morphine

Front 17

Intrathecal ______ has been found useful in ambulatory surgery.

Back 17

fentanyl

Front 18

What is the optimal dose of intrathecal fentanyl?

Back 18

15 mcg

Front 19

Benedryl works primarily on ____ receptors. Opiates release _____ that causes itching, but mast cells are not active, making it not an actual ____ response.

Back 19

H2, histamine, histamine

Front 20

What kind of opiate innately decr side effect profile?

Back 20

combo agonist/antagonist, such as nalbuphine

Front 21

What antiemetic works on H1 receptors to help decr pruritis?

Back 21

promethazine

Front 22

With intrathecal fentanyl, a consistent side effect profile is seen with a dose of _____. When increasing to a dose of ____, analgesia is not better but side effect profile is more significant.

Back 22

optimal 15 mcg
incr side effects with 20-25 mcg

Front 23

Does the addition of intrathecal fentanyl affect spinal block height?

Back 23

no

Front 24

What are the benefits/consequences of using intrathecal fentanyl as an adjunct?

Back 24

incr duration of sensory and motor blockade
earlier onset of sensory motor blockade
prolongs anesthesia without detrimental effects

Front 25

Dose range of intrathecal fentanyl

Back 25

10-17.5 mcg

Front 26

How does the potency of sufentanil compare to other opioids?

Back 26

500x more potent than morphine
5-10x more potent than fentanyl

Front 27

What is the dose range for intrathecal sufentanil?

Back 27

1.5-15 mcg (optimal 1.5 mcg)

Front 28

How does the side effect profile of intrathecal sufentanil compare to other inthrathecal opioids?

Back 28

higher side effect profile in sufentanil (esp if dose exceeds 7.5 mcg)

Front 29

Intrathecal sufentanil is associated with signifcantly higher incidence of ....

Back 29

fetal bradycardia

Front 30

Why is it helpful to mix intrathecal LA and opioids?

Back 30

can use lower doses of each and therefore have lower side effect profiles of each

Front 31

What is the epidural dose of morphine?

Back 31

1.5-5 mg

Front 32

At what dose of epidural moprhine does side effect profile dramatically increase?

Back 32

> 3 mg

Front 33

Which type of regional opioids have higher side effect profiles with lower analgesic efficacy?

Back 33

epidural

Front 34

_____ is associated with higher incidence of side effects than other conventional opioids after epidural admin.

Back 34

PF morphine

Front 35

What is the duration of epidural opioids?

Back 35

12-24 hrs

Front 36

Biphasic modality

Back 36

esp with resp depression, pt still has side effects several hours after initial dosing

Front 37

There is no additional analgesic benefit shown after ____ mg epidural morphine.

Back 37

3.75

optimal 2.5-3.75 mg

Front 38

Epidural PF morphine is best if used in combination with ____.

Back 38

fentanyl

Front 39

How do onsets compare for epidural fentanyl and morphine?

Back 39

fentanyl 5-15 min (lipid sol, faster onset)
morphine 30-60 min (water sol, slow onset)

Front 40

Studies suggest that ______ adjuncts prolong analgesia with incr block height.

Back 40

alpha 2 agonists

Front 41

Where can alpha 2 agonist adjuncts be used?

Back 41

neuraxial and PNB

Front 42

What is the primary concern with adjunct use of alpha 2 agonists?

Back 42

side effect profile

Front 43

What type of surgery is intrathecal clonidine particularly useful in doses < 75 mcg?

Back 43

orthopedic surgery

Front 44

Precedex and clonidine are comparable to bupivacaine in length of pain relief, but when combined add ___ hours of relief to LA alone.

Back 44

3-4 hrs

Front 45

Recommended dose of adjunct clonidine?

Back 45

<12 mg

Front 46

Recommended dose of adjunct precedex?

Back 46

< 3 mcg

Front 47

Do alpha 2 agonist adjuncts affect spinal block height?

Back 47

nope!

Front 48

Is clonidine useful in brachial plexus blocks?

Back 48

nope!

Front 49

What are the most effective adjunts to add to peripheral nerve blocks such as brachial plexus and femoral sciatic sites?

Back 49

epinephrine** and fentanyl

Front 50

What are the drawbacks of adding adjuncts to PNBs?

Back 50

incr side effects and hemodynamic changes