Recommendations for spinal opioids clinical practice.

What is it about?

Opioids are the most potent centrally acting analgesic drugs for the treatment of pain. On the recent years, since the discovery of spinal opioid receptors, the use of spinal opioids has been adopted in clinical practice in the hope of producing intense segmental analgesia that was devoid of the dose-limiting side effects associated with systemic opioid administration. Experimental and clinical studies have demonstrated that after their neuraxial administration, liposolubility is inversely proportional to their spinal selectivity, which is higher for morphine, than for other more lipophilic drugs, such as fentanyl and sufentanil. In recent years, more information has been available regarding the use of spinal opioids alone or in combination with LA, which has helped us to define the clinical applicability and efficacy of these forms of therapy and has also contributed to the understanding of the disadvantages of their use. This knowledge could be used to select a treatment based on patient´s particular needs and personal physician experience in the perioperative setting in order to produce a high-quality pain control combined with a low incidence of adverse effects, but this decision should be pivot on published medicine evidence data. Finally, physicians should reach a consensus on this topic and an international protocol should be adopted for proper patients monitoring after spinal opioids administration to avoid the feared respiratory depression and also other minor adverse effects.

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