Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia

Abstract

The anesthesia-enhancing properties and side-effect profile of lipophilic opioids administered intrathecally suggest significant roles for these agents as adjuncts to spinal anesthesia for obstetric and outpatient procedures.

Effect of Adding Dexmedetomidine versus Fentanyl to Intrathecal Bupivacaine on Spinal Block Characteristics in Gynecological Procedures: A Double Blind Controlled Study

“…Kuusniemi et al [15 ] reported that different durations of spinal anesthesia were related to different doses of spinal bupivacaine supplemented with 25 µg fentanyl in patients undergoing urology procedures. Hamber et al [17] in a review article found that a dose of 20-30 µg fentanyl as adjunct to spinal anesthesia produces faster block onset time, improved intraoperative analgesia and decrease incidence of intraoperative nausea and vomiting in obstetric patients.…”

Clinical effects of intrathecal fentanyl on shoulder tip pain in laparoscopic total extraperitoneal inguinal hernia repair under spinal anaesthesia: A double-blind, prospective, randomized controlled trial

“…Intrathecal opioids are usually added to local anaesthetics for spinal anaesthesia in order to improve analgesic quality without prolonging motor block. 10,11 We hypothesized that adding an opioid to hyperbaric bupivacaine for spinal anaesthesia would improve anaesthetic quality without leading to additional complications during TEP. The aim of the study was to evaluate the anaesthetic quality of intrathecal administration of bupivacaine alone, compared with bupivacaine plus fentanyl, in patients undergoing TEP under spinal anaesthesia.…”

Low-dose sufentanil dœs not potentiate intra-thecal morphine for perioperative analgesia after major colorectal surgery

“…First, low-doses of IT lipophilic opiods such as fentanyl or sufentanil provide rapid and effective analgesia during labour. 1,13 In addition, low doses of ITS (2.5-10 µg) combined with a local anesthetic hasten the onset of block, and improve intraoperative and postoperative analgesia for two to five hours after Cesarean delivery. 1,13 Our second argument to opt for this ITS dosage was based on a study conducted by Lu et al 22 investigating the dose response of ITS (12.5, 25, or 50 µg) in young adult female volunteers.…”

“…1,13 In addition, low doses of ITS (2.5-10 µg) combined with a local anesthetic hasten the onset of block, and improve intraoperative and postoperative analgesia for two to five hours after Cesarean delivery. 1,13 Our second argument to opt for this ITS dosage was based on a study conducted by Lu et al 22 investigating the dose response of ITS (12.5, 25, or 50 µg) in young adult female volunteers. The authors observed patients' response to lower extremity pain and concluded that doses larger than 12.5 µg did not improve the speed of onset, magnitude, or duration of analgesia but only produced a dose-related increase in side effects (nausea, vomiting and respiratory depression).…”

“…1 Its analgesic efficacy at low-doses (2.5-10 µg) combined to a local anesthetic is well documented in obstetrics where it improves analgesia during labour and intraoperative Cesarean delivery. [9][10][11][12][13] In abdominal surgery, sufentanil is usually administered epidurally or intravenously 14,15 and the clinical experience in non-vascular major abdominal surgery with ITS is still limited. A recent study in major abdominal surgery showed that a large dose of ITS (150 µg) was able to blunt the intraoperative stress response and produced effective analgesia, but was associated with prolonged mechanical ventilation.…”