A special mention must be made here about the novel ways of using neuraxial regional anesthesia anticoagulation . The use started in 1979.
Gradually they have become very popular and almost all the clinically available opioids have been tried by this route.
Nowadays the flexibility of neuraxial regional anesthesia anticoagulation is available to be given as Single Shot Techniques, either preemptively or at the time of inducing analgesia; as intermittent techniques, or as continuous infusion through indwelling epidural catheters.
Neuraxial regional anesthesia anticoagulation is given as:
1. Single agents exclusively for postoperative analgesia.
2. Adjuvants to local analgesics
Various drugs from the pharmacological spectrum have been tried, almost all of the pure agonists, partial agonist like buprenorphine, agonist-antagonist pentazocine, butorphanol, etc, with variety of effects, sideeffects.
One conclusion is clear that all of these neuraxial regional anesthesia anticoagulation drugs produce varied effects at varied doses, none of them non-effective but at the same time, with varied side effects and complications.
As is logically acceptable, the doses required would have to be decreased to almost 25—30 % of parenteral doses.
There is very clear evidence that in laminae I, II (SG cells) and V there is a very high concentration of II, , K receptors. These are also involved in “gating mechanism”. This is where neuraxial regional anesthesia anticoagulation given neuraxially is supposed to act.
When the opioids are added as adjuvants, there occurs analgesic synergism defined as: Prolonged and enhanced anti-nociception associated with co-administration of reduced doses of neuraxial regional anesthesia anticoagulation . The advantages quoted due to this analgesic synergy are as follows:
• Reduction of dosages of individual drugs with decreased incidence of side-effects or complications.
• Stable cardiovascular response.
• Inhibition of tachyphylaxis and improved intensity of neural blockade.
• Equivalent or superior analgesia as compared to epidural local analgesics or opioid alone.
• Prolongation of duration of analgesia.
• Early ambulation and better functional ability.
Out of all the drugs which have been used, fentanyl, sufentanil, buprenorphine, butorphanol, via epidural route, especially as adjuvants remain very popular. The neuraxial regional anesthesia anticoagulation however, has to be appropriately decreased as per their potency and side effects spectrum.