Korean J Pain.  2014 Jul;27(3):200-209. 10.3344/kjp.2014.27.3.200.

Current Evidence for Spinal Opioid Selection in Postoperative Pain

• Bujedo BM

• KMID: 2278222
• DOI: http://doi.org/10.3344/kjp.2014.27.3.200

Abstract

BACKGROUND
Spinal opioid administration is an excellent option to separate the desirable analgesic effects of opioids from their expected dose-limiting side effects to improve postoperative analgesia. Therefore, physicians must better identify either specific opioids or adequate doses and routes of administration that result in a mainly spinal site of action rather than a cerebral analgesic one.
METHODS
The purpose of this topical review is to describe current available clinical evidence to determine what opioids reach high enough concentrations to produce spinally selective analgesia when given by epidural or intrathecal routes and also to make recommendations regarding their rational and safety use for the best management of postoperative pain. To this end, a search of Medline/Embase was conducted to identify all articles published up to December 2013 on this topic.
RESULTS
Recent advances in spinal opioid bioavailability, based on both animals and humans trials support the theory that spinal opioid bioavailability is inversely proportional to the drug lipid solubility, which is higher in hydrophilic opioids like morphine, diamorphine and hydromorphone than lipophilic ones like alfentanil, fentanyl and sufentanil.
CONCLUSIONS
Results obtained from meta-analyses of RTCs is considered to be the 'highest' level and support their use. However, it's a fact that meta-analyses based on studies about treatment of postoperative pain should explore clinical surgery heterogeneity to improve patient's outcome. This observation forces physicians to use of a specific procedure surgical-based practical guideline. A vigilance protocol is also needed to achieve a good postoperative analgesia in terms of efficacy and security.

Keyword

epidural opioids; intrathecal opioids; postoperative pain; spinal analgesia

MeSH Terms

Alfentanil
Analgesia
Analgesics, Opioid
Animals
Biological Availability
Fentanyl
Heroin
Humans
Hydromorphone
Morphine
Pain, Postoperative*
Population Characteristics
Solubility
Sufentanil
Alfentanil
Analgesics, Opioid
Fentanyl
Heroin
Hydromorphone
Morphine
Sufentanil

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