Spinal administration

Memantine also blocks and reverses thermal hyperalgesia, mechanical al-lodynia in rat models of painful mononeuropathy without obvious effects on motor reflexes following systemic (Carlton and Hargett 1995 Eisenberg et al. 1993,1995 Suzuki et al. 2001) and local spinal administration (Chaplan et al. 

Itching around nose, urticaria (more frequent with parenteral and spinal administration)... 

Clonidine has been launched for the treatment of cancer pain (Boehringer Ingelheim). It is effective against malignant and non-malignant pain after spinal administration (Glynn et al., 1988 Eisenach et al., 1995). 

Sawynok, J. and Reid, A. Antinociception by tricyclic antidepressants in the rat formalin test differential effects on different behaviours following systemic and spinal administration, Pain 2001, 93, 51-59. 

AP5 and CPP are antagonists having a binding affinity for the NMDA receptor comparable to glutamate (Lehmann et al., 1987 Murphy et al., 1987). Spinally administered, both compounds exert antinociceptive effects (Coderre et al., 1994 Goettl et al., 1994 Kristensen et al., 1994 Leem et al., 1996). The limitation of such structures is of course their low lipophilicity which restricts their availability mainly to the periphery and usually requires spinal administration to obtain therapeutic efficacy. 

FIGURE 12-2 Sites of epidural and spinal administration of a local anesthetic. Caudal block represents epidural administration via the sacral hiatus. (From Clark JB, Queener SF, Karb VB. Pharmacological Basis of Nursing Practice. 4th ed. St Louis C V Mosby 1993 688. Reproduced with permission.]... 

In situations where central neural blockade is used, therapists should be especially aware that sensation might be diminished below the level of epidural or spinal administration. Decreased sensation to thermal agents and electrical stimulation will occur when the central block is in effect.10 Likewise, motor function may be affected in the lower extremities when local anesthetics are administered spinally or epidural-ly.10 Hence, therapists should test sensation and motor strength before applying any physical agents or attempting ambulation with patients who have received some type of central neural blockade using a local anesthetic. 

Spinal administration of histamine produces nociceptive behavior, and a recent study has suggested that this effect is partially mediated by the activation of N-methyl-D-aspartate (NMDA) receptors at polyamine binding sites (Sakurada... 

The availability of new routes of administration have led to increased utility and decreased opioid adverse drug reaction risk. Epidural and intrathecal administration through spinal catheters produces adequate regional analgesia at relatively low total doses compared with intravenous or oral routes. As such, spinal administration can thus minimize somnolence, nausea, vomiting, and respiratory depression associated with these medications. Other alternative routes include intranasal administration of butorphanol, and rectal and transdermal administration of fentanyl [28]. Availability of such options provides not only a decreased risk of adverse reactions, but also more comfortable measures for patients who would otherwise require continued intravenous administration, or for those who are unable to receive oral medication [28,29]. 

The spinal administration of morphine, with or without a local anesthetic, has been advocated for producing a sustained period of postoperative analgesia. However, adverse side effects from such analgesia include ventilatory depression, itching, and urinary retention. Morphine depresses all phases of respiration (respiratory rate, tidal volume, and minute volume) when given in subhypnotic and subanalgesic... 

At approximately 17.00 hrs on Thursday 4th January 2001, Mr David James, a day case patient on Ward E17 at the Queen s Medical Centre Nottingham (QMC), was prepared for an intrathecal (spinal) administration of chemotherapy as part of his medical maintenance programme following successful treatment of leukaemia. 

For pediatric patients undergoing posterior spinal fusion and segmental spinal administration for idiopathic scoliosis, a dose of pre-operative intrathecal morphine ranging from 9 to 19 (xg/kg with a mean of 14 (Xg/kg provided effective analgesia with a low frequency of respiratory depression and intensive care unit admission [5]. Another report of pediatric spinal fusion patients showed no advantage of 15 pg/kg intrathecal morphine over a dose of 5 pg/kg [6]. 

Chabbouh T, Lentschener C, Zuber M, Jude N, Delaitre B, Ozier Y. Persistent cauda equina syndrome with no identifiable facilitating condition after an uneventful single spinal administration of 0.5% hyperbaric bupivacaine. Anesth Analg 2005 101 (6) 1847-8. 

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