1 / 11

OPIOID TOXICITY AND SPINAL ANALGESIA

OPIOID TOXICITY AND SPINAL ANALGESIA. By Jennifer Gray Specialist Clinical Pharmacist Neurosurgery, Pain and Palliative Care Ninewells Hospital 24/09/18. Opioid Toxicity. Signs of Opioid Toxicity. Respiratory Depression Decreased level of consciousness Pin point pupils Seizures

paul
Télécharger la présentation

OPIOID TOXICITY AND SPINAL ANALGESIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. OPIOID TOXICITY AND SPINAL ANALGESIA By Jennifer Gray Specialist Clinical Pharmacist Neurosurgery, Pain and Palliative Care Ninewells Hospital 24/09/18

  2. Opioid Toxicity

  3. Signs of Opioid Toxicity • Respiratory Depression • Decreased level of consciousness • Pin point pupils • Seizures • Muscle spasms

  4. Strategies to avoid opioid toxicity • Opioid avoidance/sparing • Utilise non-pharmacological interventions • Utilise non-opioid medications • Opioid rotation – attempt to find right drug • Spinal analgesia • Other interventions • Nerve blocks • Neuro-ablative procedures e.g. Cordotomy

  5. Background • Intrathecal Drug Delivery is a method of giving medication directly into the spinal cord. • It’s an option when most other treatment options have failed • As the medications are delivered directly into the spinal cord, symptoms can be controlled with much smaller doses than would be required orally • Side effects are reduced • It is an unlicensed product

  6. The Patient • Patient requires to be relatively fit prior to procedure (e.g. no infections and blood counts satisfactory) • Improvement in pain and quality of life is the end goal • Other Analgesia will be stopped or reduced prior to insertion • Patient is followed up by the chronic pain team every month

  7. The Team • Palliative Care Consultant(s) • Pain Consultant(s) • Neurosurgeon • Palliative Pharmacist • Palliative Technician • Aseptic Pharmacist

  8. Medications Commonly Used • Hydromorphone – Is a potent opioid with increasing intraspinal “off-label” use to treat cancer and non-malignant pain. Side effects are less common compared to morphine • Clonidine – Is an a2 Agonist that enhances the analgesic affect of the opioid. It is often effective for neuropathic pain. Side effects include hypotension and sedation • Levobupivicaine /Bupivicaine – Is a sodium channel blocker used as an anaesthetic. Side effects include motor weakness and urinary retention

  9. Ordering • Order product from ITH Pharma (company that specialises in the provision of aseptic compounding services for all therapy areas) • Manufacturing and delivery is roughly a one week process • They request a copy of the prescription • Product is labelled for the patient specifically with name and CHI • The cost is around £400 per syringe

  10. Thank You Any Questions

More Related