Interesting epidural adjuvants

[ethilo]

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I read in an old textbook that potassium is actually a pretty effective adjuvant in an epidural. You'd have to be pretty ballsy injecting K into an epidural. What were those old guys thinking?? 😀

Along those lines... Anyone have experience with nontraditional adjuvants? I.e. Neostigmine, ketamine... Anything else that's weird?

 

[Aether2000]

In our acute pain service in the 1990s we frequently ran epidural bupivicaine/ketamine combination infusions. Over a certain threshold, hallucinations occurred. We also used neostigmine epidurally back then. In the 2000s, we used Sarapin, derived from the carnivorous pitcher plant. More recently, ketorolac, traumeel, and zeel have been used.

 

[anbuitachi]

anyone try tylenol?

 

[BLADEMDA]

That's crazy stuff. In this malpractice environment why would anyone put this crap in the epidural space?

 

[BLADEMDA]

I read in an old textbook that potassium is actually a pretty effective adjuvant in an epidural. You'd have to be pretty ballsy injecting K into an epidural. What were those old guys thinking?? 😀

Along those lines... Anyone have experience with nontraditional adjuvants? I.e. Neostigmine, ketamine... Anything else that's weird?

Preoperative epidural ketamine in combination with morphine does not have a clinically relevant intra- and postoperative opioid-sparing effect. - PubMed - NCBI

Postoperative pain relief after hepatic resection in cirrhotic patients: the efficacy of a single small dose of ketamine plus morphine epidurally. - PubMed - NCBI

 

[BLADEMDA]

I read in an old textbook that potassium is actually a pretty effective adjuvant in an epidural. You'd have to be pretty ballsy injecting K into an epidural. What were those old guys thinking?? 😀

Along those lines... Anyone have experience with nontraditional adjuvants? I.e. Neostigmine, ketamine... Anything else that's weird?

The evolution of spinal/epidural neostigmine in clinical application: Thoughts after two decades

 

[BLADEMDA]

I read in an old textbook that potassium is actually a pretty effective adjuvant in an epidural. You'd have to be pretty ballsy injecting K into an epidural. What were those old guys thinking?? 😀

Along those lines... Anyone have experience with nontraditional adjuvants? I.e. Neostigmine, ketamine... Anything else that's weird?

IMHO, the best of the non traditional adjuvants is Precedex. If i was going to add anything besides an opioid it would likely be precedex:

The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries

Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis. - PubMed - NCBI

CONCLUSION:
This systematic review and meta-analysis demonstrates that dexmedetomidine as an adjuvant in epidural procedures is generally safe and well tolerated. Furthermore, dexmedetomidine acted synergistically and provided an improved sedation and analgesic profile

Efficacy and Safety of Dexmedetomidine as an Adjuvant in Epidural Analgesia and Anesthesia: A Systematic Review and Meta-analysis of Randomized Con... - PubMed - NCBI

 

[BLADEMDA]

CONCLUSION:
Dexmedetomidine 5 μg given intrathecally improves the quality and the duration of postoperative analgesia and also provides an analgesic sparing effect in patients undergoing major abdominal cancer surgery. Furthermore, the addition of intrathecal fentanyl 25 μg has no valuable clinical effect.

Efficacy of intrathecally administered dexmedetomidine versus dexmedetomidine with fentanyl in patients undergoing major abdominal cancer surgery. - PubMed - NCBI

 

[deleted162650]

In training it was pretty routine to add clonidine to pediatric caudals. Not sure if you want to count that.

 

[deleted59964]

hmmm i like bupivicaine