Spinal Opioids in Anesthetic Practice

Excerpt

Regional anesthesia, consisting of spinal, caudal, and epidural blocks, was first utilized for surgical procedures at the turn of the twentieth century. Initially deemed unsafe due to reports of permanent neurologic injury, a large-scale study in the 1950s proved complications were rare when blocks were performed skillfully and with attention to sterile technique, combined with the improved safety profile of injected medications. Initial work showing improved pain management in cancer patients has expanded spinal opioids for postoperative pain management. (Katz, 1981; Cunningham, 1983; Vanstrum, 1988).

Spinal anesthesia now has a long track record of safety. In some circumstances, it is the anesthetic of choice and, at times, even the safest option. While local anesthetics are used to provide surgical anesthesia, they are often combined with intrathecal (IT) opioids to supplement intraoperative analgesia and provide postoperative analgesia once the local anesthetic has worn off. Spinal opioids are also used to manage chronic pain, sometimes as single injections, but more often via implantable infusion pumps.