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Spinal opioids 

Chapter:
Spinal opioids
Author(s):

Karen H. Simpson

and Ganesan Baranidharan

DOI:
10.1093/med/9780199218806.003.0015
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date: 05 December 2020

Spinal opioids mediate their main actions via mu receptors in the brain and in the substantiagelatinosa within the dorsal horn of the spinal cord. Neuraxial opioids can be very useful when the World Health Organization (WHO) analgesic ladder fails to provide adequate analgesia or leads to unmanageable adverse effects. Intrathecal drug delivery has advantages over epidural drug delivery such as low dose requirements and fewer longer-term complications. Careful patient selection is crucial and should include intrathecal test dosing. Multidisciplinary team work and good post-procedure support are essential for the ongoing management of intrathecal drug delivery to optimize analgesia and manage adverse events.

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