Specialties CRNA
Published Oct 31, 2002
sbic56, BSN, RN
1,437 Posts
How does somnolence occur with a bivucaine/Fentenyl epidural? I was under the impression that the narcotic never left its' intended space.
kmchugh
801 Posts
Originally posted by sbic56 How does somnolence occur with a bivucaine/Fentenyl epidural? I was under the impression that the narcotic never left its' intended space.
First, if the narcotic never left the "intended space," the epidural space, it would never be metabolized and would forever more affect the patient. We try to use narcotics with a somewhat shorter half life than "forever." The epidural space does have a blood supply, and all medications injected into it are eventually taken out and undergo metabolism and elimination.
But, that doesn't really have anything to do with your initial question, which is why somnolence occurs with a narcotic containing epidural. Like nearly all other drugs, narcotics achieve their intended effect through a drug-receptor interaction. Suffice it to say that the receptors involved in pain control and sedation can be affected by medication injected into the epidural space, and therefore, in sufficient doses, fentanyl administered epidurally can cause sedation, somnolence, depressed respiration, and all the other effects narcotics are known for.
Kevin McHugh, CRNA
Thanks Kevin. Totally makes sense now; I appreciate the thorough answer. One more question: How common is it for a patient with an epidural to experience vertigo? I've only seen it once, but it was quite extreme for this patient.
Originally posted by sbic56 Thanks Kevin. Totally makes sense now; I appreciate the thorough answer. One more question: How common is it for a patient with an epidural to experience vertigo? I've only seen it once, but it was quite extreme for this patient.
I have not seen vertigo with epidurals, but I can think of a couple of different mechanisms by which it would occur. I'd need to know more about the specifics to try to guess why the patient had this problem. But, it can happen.
Brenna's Dad
394 Posts
That's interesting kevin.
I always thought that pts with an epideral might experience sedation/somnolence because of the medication being absorbed or injected into the blood vessels supplying the epideral space and then into systemic circulation.
Edited for early morning stupidity