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.

Spinal anesthesia has developed a well-established record of safety over decades of clinical use. In certain situations, clinicians regard it as the anesthetic of choice and, in select cases, the safest available option. Local anesthetics provide the foundation for surgical anesthesia, yet they are frequently paired with intrathecal opioids to enhance intraoperative analgesia and extend pain relief into the postoperative period once the local anesthetic effect diminishes.

Intrathecal opioids deliver effective analgesia while avoiding sympathetic and motor blockade, offering targeted pain control with fewer physiologic disruptions. Their utility extends beyond perioperative care into the management of chronic pain. Clinicians may administer them as single injections for select patients, but more commonly employ implantable infusion pumps to deliver sustained, long-term relief in individuals with complex pain syndromes.