Epidural and spinal opioids

Epidural and spinal opioid use has developed into a well established mode of perioperative anesthetic and analgesic management. A large number of studies have examined factors important in determining the efficacy and the extent of side effects of such therapy. This article reviews some of the most recent studies which have examined aspects of epidural and spinal opioids' therapeutic use. These studies have clarified some areas of the clinical pharmacology of neuraxial opioids administered alone or in combination with adjunctive agents. Several of these studies have provided insight into the subtleties which determine the effects observed in clinical application of these techniques. Future studies will need to define the optimal methods of applying this modality and further quantify its impact on outcome parameters such as patient satisfaction and overall cost.