Spinal opioid XXXX . A critical update.

@entity1 @entity5 @entity1337 @entity158 @entity1286
Small spinal (intrathecal or extrathecal) doses of opioids induce a long-lasting and regional analgesic effect in various experimental animal models. Nowadays extrathecal @entity1286 administration is considered an established method of controlling postoperative and @entity5 -induced @entity158 conditions. The potency of @entity1286 applied by the spinal route is higher than when the drug is applied by the intravenous (IV) route. Opioids which are more lipophilic than @entity1286 will provide a marginally better analgesic effect when administered by the spinal route as compared with the IV route. Several controlled clinical trials in postoperative @entity1 have demonstrated that a single dose of @entity1286 administered by the spinal route gives a more long-lasting action than a similar IV dose. It is not known whether frequent @entity1 -controlled administration of @entity1286 may provide equally good @entity1337 without additional side effects. The use of spinal @entity1286 in the treatment of @entity5 -related @entity158 is based on clinical experience only. There are risks in replacing opioid administration by the oral or IV route with spinal opioids. @entity1286 should only be used in selected cases until the advantage of spinal opioid @entity1337 to control postoperative and @entity5 has been clearly defined in well-designed clinical studies. Spinal @entity1286 dosages must be individualised according to the intensity of the nociceptive stimuli and should take into account intra-individual variability in drug responses due to pharmacokinetic and pharmacodynamic factors.
