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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on May 2, 2008
Continuing Education in Anaesthesia, Critical Care & Pain 2008 8(3):81-85; doi:10.1093/bjaceaccp/mkn016
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Intrathecal opioids in the management of acute postoperative pain

Andrew Hindle, MB ChB, BSc (Hons), DA, FRCA
Consultant Anaesthetist
Department of Anaesthesia
North Cheshire NHS Trust
Warrington Hospital
Lovely Lane
Warrington
WA5 1QG
UK
Tel: +44 192 566 2232 Fax: +44 162 554 9554 E-mail: intrathecaldoc@aol.com

Key Words: Increased lipophilicity is associated with reduced analgesic potency in the cerebrospinal fluid (CSF). • Intrathecal diamorphine becomes less lipophilic after injection as a result of metabolism in the CSF and spinal cord. • After lumbar CSF injection of a hydrophilic opioid, there is slow cephalad and circumferential spread. • There is no correlation between side-effects and dose of intrathecal opioid in the acute pain setting. • Systemic dose potency ratios of opioids are different from their intrathecal counterparts.

The first 150 words of the full text of this article appear below.

In 1968, Melzack and Wall put forward their ‘gate control theory’ proposing that the spinal cord was a potential target site for modulation of pain signals. This changed our concepts about nociceptive transmission and laid the foundation for further research into dorsal horn opioid pharmacology. This led to the discovery of opioid receptors by Pert and Snyder in 1973 and the subsequent identification of dorsal horn opioid receptors by radioligand techniques in 1977. Yaksh went on to demonstrate that opioids modulate nociceptive stimuli via a direct action on the spinal cord in 1976.

Wang was the first to describe the intrathecal administration of morphine in a group of eight patients with genitourinary malignancies in 1979. Since that time, the use of intrathecal opioids has become a widely accepted technique for providing effective postoperative pain relief. The changing health economy has driven the need for greater patient throughput, rapid turnover and . . . [Full Text of this Article]


   Site of action
 

   Physicochemical properties
 

   Pharmacokinetics
 
Lipophilic opioids

Diamorphine

Hydrophilic opioids


   Intrathecal opioids and postoperative pain
 
Day case surgery

Obstetrics

Orthopaedic surgery

Hip and knee arthroplasty

Spinal surgery

General surgery and urology


   Side-effects of intrathecal opioids
 
Respiratory depression

Pruritus

Neurotoxicity


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