Articles: analgesics.
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Small doses of epidural and intrathecal opioids produce effective and prolonged analgesia postoperatively, although the quality of analgesia does not differ from when conventional routes are used. The different opioids differ only in the speed of onset and duration of action, and in the incidence of side-effects. 'Minor' complications such as nausea, vomiting, pruritus and retention of urine are relatively common. ⋯ It is commoner after morphine and after intrathecal administration, and is also associated with advanced age, concomitant use of other central depressant drugs, respiratory disease and large doses. Because of the potentially lethal nature of this complication, it is recommended that the epidural and intrathecal routes of administration are used only when patients can be closely and constantly observed postoperatively.
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Although the scientific study of pain in the modern sense was initiated 150 years ago, and a number of theories were subsequently proposed, until two decades ago pain research remained conceptually stagnant and the meager amount done was not commensurate with the magnitude and clinical importance of pain. Consequently, pain treatment remained somewhat empirical and ineffective. ⋯ Fortunately, during the past 20 years significant advances have been made in our knowledge of basic mechanisms of acute pain and about some chronic pain syndromes, and a variety of new therapeutic modalities have been introduced and old ones have been refined. Among the most important advances of the past decade have been the discovery of opiate receptors, the extensive pharmacokinetic and pharmacodynamic studies of narcotics, the development of very sensitive analytic techniques and mathematic knowledge and many other advances which have prompted the development of new drugs, novel drug preparations and novel methods of administration, of which intraspinal narcotic therapy is the most important and widely used.
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Opioids were available in clinical practice since before the birth of modern anaesthesia--Setürner isolated morphine in 1806. They have a record of safety which is reflected in their high therapeutic ratios, especially the synthetic opioids introduced recently (table III). The most serious immediate adverse effect, respiratory depression, is a predictable effect related closely to analgesia. It is fortunate for anaesthetists who use opioids regularly, that recognition and treatment of respiratory problems are an integral part of their craft and that opioid antagonists are effective in reversing respiratory depression.
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Int Anesthesiol Clin · Jan 1986
Review Comparative StudyEpidural versus intrathecal route of opioid administration.