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The Options for Neuraxial Drug Administration
Neuraxial drug administration, i.e., the injection of drugs into the epidural or intrathecal space to produce anesthesia or analgesia, is a technique developed more than 120 years ago. Today, it still is widely used in daily practice in anesthesiology and in acute and chronic pain therapy. A multitu...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345828/ https://www.ncbi.nlm.nih.gov/pubmed/35836037 http://dx.doi.org/10.1007/s40263-022-00936-y |
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author | Hermanns, Henning Bos, Elke M. E. van Zuylen, Mark L. Hollmann, Markus W. Stevens, Markus F. |
author_facet | Hermanns, Henning Bos, Elke M. E. van Zuylen, Mark L. Hollmann, Markus W. Stevens, Markus F. |
author_sort | Hermanns, Henning |
collection | PubMed |
description | Neuraxial drug administration, i.e., the injection of drugs into the epidural or intrathecal space to produce anesthesia or analgesia, is a technique developed more than 120 years ago. Today, it still is widely used in daily practice in anesthesiology and in acute and chronic pain therapy. A multitude of different drugs have been introduced for neuraxial injection, only a part of which have obtained official approval for that indication. A broad understanding of the pharmacology of those agents is essential to the clinician to utilize them in a safe and efficient manner. In the present narrative review, we summarize current knowledge on neuraxial anatomy relevant to clinical practice, including pediatric anatomy. Then, we delineate the general pharmacology of neuraxial drug administration, with particular attention to specific aspects of epidural and intrathecal pharmacokinetics and pharmacodynamics. Furthermore, we describe the most common clinical indications for neuraxial drug administration, including the perioperative setting, obstetrics, and chronic pain. Then, we discuss possible neurotoxic effects of neuraxial drugs, and moreover, we detail the specific properties of the most commonly used neuraxial drugs that are relevant to clinicians who employ epidural or intrathecal drug administration, in order to ensure adequate treatment and patient safety in these techniques. Finally, we give a brief overview on new developments in neuraxial drug therapy. |
format | Online Article Text |
id | pubmed-9345828 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-93458282022-08-04 The Options for Neuraxial Drug Administration Hermanns, Henning Bos, Elke M. E. van Zuylen, Mark L. Hollmann, Markus W. Stevens, Markus F. CNS Drugs Review Article Neuraxial drug administration, i.e., the injection of drugs into the epidural or intrathecal space to produce anesthesia or analgesia, is a technique developed more than 120 years ago. Today, it still is widely used in daily practice in anesthesiology and in acute and chronic pain therapy. A multitude of different drugs have been introduced for neuraxial injection, only a part of which have obtained official approval for that indication. A broad understanding of the pharmacology of those agents is essential to the clinician to utilize them in a safe and efficient manner. In the present narrative review, we summarize current knowledge on neuraxial anatomy relevant to clinical practice, including pediatric anatomy. Then, we delineate the general pharmacology of neuraxial drug administration, with particular attention to specific aspects of epidural and intrathecal pharmacokinetics and pharmacodynamics. Furthermore, we describe the most common clinical indications for neuraxial drug administration, including the perioperative setting, obstetrics, and chronic pain. Then, we discuss possible neurotoxic effects of neuraxial drugs, and moreover, we detail the specific properties of the most commonly used neuraxial drugs that are relevant to clinicians who employ epidural or intrathecal drug administration, in order to ensure adequate treatment and patient safety in these techniques. Finally, we give a brief overview on new developments in neuraxial drug therapy. Springer International Publishing 2022-07-15 2022 /pmc/articles/PMC9345828/ /pubmed/35836037 http://dx.doi.org/10.1007/s40263-022-00936-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Review Article Hermanns, Henning Bos, Elke M. E. van Zuylen, Mark L. Hollmann, Markus W. Stevens, Markus F. The Options for Neuraxial Drug Administration |
title | The Options for Neuraxial Drug Administration |
title_full | The Options for Neuraxial Drug Administration |
title_fullStr | The Options for Neuraxial Drug Administration |
title_full_unstemmed | The Options for Neuraxial Drug Administration |
title_short | The Options for Neuraxial Drug Administration |
title_sort | options for neuraxial drug administration |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345828/ https://www.ncbi.nlm.nih.gov/pubmed/35836037 http://dx.doi.org/10.1007/s40263-022-00936-y |
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