Abstract

VIDAL, M. A.; ARAGON, M. C.  and  TORRES, L. M.. Opiates as co-adjuvants of epidural analgesia in pediatrics. Rev. Soc. Esp. Dolor [online]. 2005, vol.12, n.6, pp.348-356. ISSN 1134-8046.

There is a high number of opiate receptors located at the gelatinous substance of the medullar dorsal horn. Epidural injection of opiates allows saturable and competitive binding to these receptors, thus providing analgesia and reducing the risk of side effects associated to their parenteral administration. However, potential side effects must be taken into account, the major complication being respiratory depression. Morphine is the mu agonist opiate most commonly used for the management of acute and chronic pain and is the standard analgesia with which new analgesics are compared. Fentanyl is an opiate agonist derived from fenyl pyperidine with a high affinity for mu receptors and hence with an analgesic power that is 50-100 times greater than morphine. Tramadol is the most recent synthetic opiate used in Spain. It has a low affinity for mu, kappa and delta receptors. However, its analgesic power compared to morphine is 1/10 when parenterally administered and 1/30 when epidurally administered. Epidural opiates had been widely used in adults, but much less frequently used in pediatrics. This paper reviews various studies that have determined its effects in Pediatrics, with reference to pharmacokinetics, clinical considerations and possible side effects after the epidural administration of morphine, fentanyl or tramadol.

Keywords : Opiates; Pediatrics; Edpidural analgesia.

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