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Survey of intrathecal opioid usage in the UK

Published online by Cambridge University Press:  01 February 2008

M. Giovannelli ,
N. Bedforth  and
A. Aitkenhead
M. Giovannelli*
Affiliation:
Derby Hospitals NHS Foundation Trust, Department of Critical Care, Derby, UK
N. Bedforth
Affiliation:
Queen’s Medical Centre, Department of Anaesthesia, Nottingham, UK
A. Aitkenhead
Affiliation:
Queen’s Medical Centre, Department of Anaesthesia, Nottingham, UK
*
Correspondence to: Marco A. Giovannelli, Department of Critical Care, Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK. E-mail: [email protected]; Tel: 01332 347141; Fax: 01332 258118
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Summary

Background and objective

Intrathecal opioids are now used routinely in the UK for intra- and postoperative analgesia. The opioids of choice have altered over recent years and the dosage regimens used can vary between institutions. Concerns over safety have been reduced probably because much lower doses of opioids are now being used. This survey explored the practice of intrathecal opioid usage in the UK.

Methods

We sent a questionnaire survey to 270 anaesthetic departments and received 199 replies, a response rate of 73.7%.

Results

Intrathecal opioids were used in 175 (88.4%) departments. Of these departments, 107 (61.1%) had local guidelines or protocols in place. Opioids such as diamorphine (used in 136 (78.2%) of departments) and fentanyl (129 (74.1%)) with a shorter duration of action are now more commonly used than morphine (37 (21.3%)) for intrathecal analgesia. In 96 (54.5%) departments, patients were nursed on regular surgical wards following administration of spinal opioids.

Conclusions

The use of low-dose lipophilic intrathecal opioids for postoperative analgesia is widespread in the UK. Patients are commonly nursed in low-dependency post-anaesthetic care areas. The low incidence of adverse events reported by the respondents along with the popularity of the technique suggests that low-dose spinal opioid administration is safe.

Keywords

ANAESTHESIASPINALANALGESICS OPIOID, morphine, fentanyl, diamorphineANAESTHESIA RECOVERY PERIODGUIDELINES
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 2 , February 2008 , pp. 118 - 122
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Racoviceanu-Pitesti, N. Anesthesia generala prin cocaina. Rev Chir 1900; IV: 11–22.Google Scholar
2.Rawal, N, Arner, S, Gustafsson, L, Allvin, R. Present state of extradural and intrathecal opioid analgesia in Sweden. Br J Anaesth 1987; 59: 791–799.CrossRefGoogle ScholarPubMed
3.Rawal, N, Allvin, R. Acute pain services in Europe: a 17-nation survey of 105 hospitals. Eur J Anaesthesiol 1998; 15 (3): 354–363.CrossRefGoogle ScholarPubMed
4.Du Pen, S, Ramsey, D, Chin, S. Chronic epidural morphine and preservative-induced injury. Anesthesiology 1987; 67: 987–988.CrossRefGoogle ScholarPubMed
5.Mathews, E. Epidural morphine (Letter). Lancet 1979; 1: 673.Google Scholar
6.Morgan, M. Intrathecal and epidural opiates: an assessment. Anaesthesia 1982; 37: 1365–1366.Google Scholar
7.Morgan, M. The rational use of intrathecal and epidural opioids. Br J Anaesth 1989; 63: 165–188.CrossRefGoogle Scholar
8.Nordberg, G, Hedner, T, Mellstrand, T, Dahlström, B. Pharmacokinetic aspects of intrathecal morphine analgesia. Anesthesiology 1984; 60: 448–454.CrossRefGoogle ScholarPubMed
9.Sjöström, S, Tamsen, A, Persson, M, Hartvig, P. Pharmacokinetics of intrathecal morphine and meperidine in humans. Anesthesiology 1987; 67: 889–895.Google Scholar
10.DiChiro, G. Observation on the circulation of the cerebrospinal fluid. Acta Radiol Diagn 1966; 5: 988–1002.CrossRefGoogle Scholar
11.Shook, J, Watkins, W, Camporesi, E. Differential roles of opioid receptors in respiration, respiratory disease, and opiate-induced respiratory depression. Am Rev Respir Dis 1990; 142: 895–909.CrossRefGoogle ScholarPubMed
12.Mueller, R, Lundberg, D, Breese, G, Hedner, J, Hedner, T, Jonason, J. The neuropharmacology of respiratory control. Pharmacol Rev 1982; 34: 255–285.Google ScholarPubMed
13.Gregory, M, Brock-Utne, J, Bux, S, Downing, J. Morphine concentration in brain and spinal cord after subarachnoid morphine injection in baboons. Anesth Analg 1985; 64: 929–932.Google Scholar
14.Jordan, C. Assessment of the effects of drugs on respiration. Br J Anaesth 1982; 54: 763–782.CrossRefGoogle ScholarPubMed
15.Ko, S, Goldstein, DH, VanDenKerkhof, EG. Definitions of ‘respiratory depression’ with intrathecal morphine postoperative analgesia: a review of the literature. Can J Anaesth 2003; 50 (7): 679–688.Google Scholar
16.Ready, L, Oden, R, Chadwick, H et al. . Development of an anesthesiology-based postoperative pain management service. Anesthesiology 1988; 68: 100–106.Google Scholar
17.Bailey, P, Rhondeau, S, Schafer, P et al. . Dose–response pharmacology of intrathecal morphine in human volunteers. Anesthesiology 1993; 79: 49–59.CrossRefGoogle ScholarPubMed
18.Chaney, M. Pulse oximetry during conscious sedation (Letter). JAMA 1994; 271: 429.CrossRefGoogle Scholar
19.Etches, RC, Sandler, AN, Daley, MD. Respiratory depression and spinal opioids [see comment]. Can J Anaesth 1989; 36 (2): 165–185.CrossRefGoogle ScholarPubMed
20.Gustafsson, L, Schildt, B, Jacobsen, K. Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden. Br J Anaesth 1982; 54: 479–486.Google Scholar
21.Palmer, C. Early respiratory depression following intrathecal fentanyl-morphine combination. Anesthesiology 1991; 74: 1153–1155.CrossRefGoogle ScholarPubMed
22.Hays, R, Palmer, C. Respiratory depression after intrathecal sufentanil during labor. Anesthesiology 1994; 81: 511–512.CrossRefGoogle ScholarPubMed
23.Gwirtz, K, Young, J, Byers, R et al. . The safety and efficacy of intrathecal opioid analgesia for acute postoperative pain: seven years’ experience with 5969 surgical patients at Indiana University Hospital. Anesth Analg 1999; 88: 599.Google Scholar
24.Cousins, M, Mather, E. Intrathecal and epidural administration of opioids. Anesthesiology 1984; 61: 276–310.Google ScholarPubMed
25.Coleman, J, Dolin, S. Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data. Br J Anaesth 2004; 93: 212–223.Google Scholar
26.Miller, R, Greenblatt, D. Drug effects in hospital patients. In: Miller, RR, Greenblatt, DJ, eds. Experiences of the Boston Collaborative Drug Surveillance Program, 1966–1975. New York: John Wiley and Sons, 1976.Google Scholar
27.Bromage, P, Camporesi, E, Durant, P, Nielson, C. Nonrespiratory side effects of epidural morphine. Anesth Analg 1982; 61: 490–495.CrossRefGoogle ScholarPubMed
28.Aguilar, J, Benhamou, D, Bonnet, F et al. . ESRA guidelines for the use of epidural opioids. Int Monitor Reg Anaesth 1997; 9: 3–8.Google Scholar