Send to

Choose Destination
See comment in PubMed Commons below
Anaesthesia. 2006 Jul;61(7):659-64.

The site of action of epidurally administered opioids and its relevance to postoperative pain management.

Author information

Leeds University Medical School, Leeds, UK.


The use of epidurally administered opioids to control postoperative pain is a well established and widely accepted technique. However, despite this longstanding use, there is still an ongoing debate concerning the site of action of the opioids used. Some argue that analgesia is mediated by a spinal mechanism and others that a supraspinal mechanism is responsible. On close inspection of the evidence it becomes apparent that epidural opioids act predominantly spinally when administered as a bolus, and predominantly supraspinally when administered as a continuous infusion. A concentration of 10 microg x ml(-1) appears to be the threshold at which epidurally administered fentanyl can elicit segmental analgesia, a value which may have significant clinical applications. The evidence supporting a synergistic relationship between epidural opioids and local anaesthetics is weak and unsupported by a plausible physiological mechanism. Thus the 'threshold concentration' of approximately 10 microg x ml(-1) is unlikely to be lowered by co-administering opioids with local anaesthetics.

[Indexed for MEDLINE]
Free full text
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Wiley
    Loading ...
    Support Center