SciELO - Scientific Electronic Library Online

 
vol.19 issue2Effectiveness of the administration of epidural and paravertebral ozone at a concentration of 50 μg/ml in patients with chronic pain secondary to postlaminectomy syndromeFibromyalgia: A disorder of oxidative stress author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

  • On index processCited by Google
  • Have no similar articlesSimilars in SciELO
  • On index processSimilars in Google

Share


Revista de la Sociedad Española del Dolor

Print version ISSN 1134-8046

Abstract

MUGABURE BUJEDO, B.; GONZALEZ SANTOS, S.; URIA AZPIAZU, A.  and  TORAN GARCIA, L.. Up to date in clinical management of neuraxial opioids for the treatment of postoperative pain. Rev. Soc. Esp. Dolor [online]. 2012, vol.19, n.2, pp.72-94. ISSN 1134-8046.

Opioids are the strongest drugs currently used for the treatment of pain. Over the last 40 years, because of the discovery of the spinal cord opioid receptors, the use of spinal opioids has become a standard for producing intense segmental analgesia without side effects associated with systemic administration. There is a widespread misconception that any opioid administered epidurally or intrathecally will always produce analgesia by a selective mechanism without central adverse effects. This is simply not true because multiple of these opioids produce analgesia by uptake into the systemic circulation or cerebrospinal fluid (CSF), with subsequent redistribution to brain opioid receptors. The findings indicate that increasing lipid solubility decreases the spinal cord bioavailability, therefore morphine is the most spinally selective opioid currently used in the epidural and intrathecal spaces. Extended release epidural morphine (EREM) utilizes a proprietary liposomal carrier to provide prolonged analgesia without the need for an indwelling catheter. Fentanyl is the best option for ambulatory surgery and it becomes apparent that epidural fentanyl acts predominantly spinally when administered as a bolus, and predominantly supraspinally as a continuous infusion. Epidural methadone and hydromorphone are valid alternatives for improve analgesia in the postoperative setting. All opioids injected intrathecally can be expected to produce analgesia, at last in part, by a spinal mechanism. The principal difference among opioids is in their duration of analgesic action, speed of re-distribution and the mechanism by which the drug reaches brainstem sites. In general, lipophilic opioids produce short durations of action (1-4 hours), which makes them attractive for short-term postoperative states. However, morphine doses of only 100 to 200 μg produce potent analgesia lasting as long as 24 hours.

Keywords : Spinal analgesia; Epidural opioid; Intrathecal opioid; Postoperative pain.

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )

 

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License