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Side effects of intrathecal and epidural opioids

  • Review Article
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Abstract

The purpose of this article is to review the literature on the side effects of intrathecal and epidural opioids. English-language articles were identified through a MEDLINE search and through review of the bibliographies of identified articles. With the increasing utilization of intrathecal and epidural opioids in humans during the 1980s, a wide variety of clinically relevant side effects have been reported. The four classic side effects are pruritus, nausea and vomiting, urinary retention, and respiratory depression. Numerous other side effects have also been described. Most side effects are dose-dependent and may be more common if the opioid is administered intrathecally. Side effects are less common in patients chronically exposed to either intrathecal, epidural, or systemic opioids. Some side effects are mediated via interaction with specific opioid receptors while others are not. It is concluded that the introduction of intrathecal and epidural opioids marks one of the most important breakthroughs in pain management in the last two decades. However, a wide variety of clinically relevant non-nociceptive side effects may occur. All physicians utilizing intrathecal and epidural opioids must be aware of these side effects, for while most are minor, others are potentially lethal.

Résumé

Ce travail constitue un survol de la littérature portant sur les effets secondaires des morphiniques sous-arachnoïdiens et épiduraux. Les articles en langue anglaise ont été identifiés grâce à une recherche sur Medline et une revue des bibliographies des articles trouvés de cette façon. Avec l’utilisation croissante des morphiniques sous-arachnoïdiens et épiduraux débutée dans les années 80, on a décrit avec pertinence une grande variété d’effets secondaires convaincants. Les quatres effets secondaires classiques sont le prurit, les nausées et les vomissements, la rétention urinaire et la dépression respiratoire; ce ne sont toutefois pas les seuls effets secondaires rapportés. La plupart dépendent de la dose et sont plus fréquents lorsque le morphinique est administré par la voie sous-arachnoïdienne. Les effets secondaires surviennent moins souvent chez les patients exposés de façon chronique à des morphiniques sousarachnoïdiens, épiduraux ou systémiques. Quelques-uns des effets secondaires résultent de l’interaction de récepteurs morphiniques spécifiques mais pas tous. Les auteurs concluent que l’introduction des morphiniques sous-arachnoïdiens et épiduraux représente la percée la plus importante des deux dernières décennies dans le domaine du traitement de la douleur. Cependant, des effets secondaires multiples de nature non-nociceptive sont susceptibles de survenir. Tous les médecins utilisateurs de morphinique sous-arachnoïdiens et épiduraux doivent connaître ces effets secondaires qui sont mineurs pour la plupart, alors que d’autres sont potentiellement létaux.

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  1. Department of Anesthesiology, Foster G. McGaw Hospital, Loyola University Medical Center, 2160 South First Avenue, 60153, Maywood, Illinois

    Mark A. Chaney

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  1. Mark A. Chaney

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Chaney, M.A. Side effects of intrathecal and epidural opioids. Can J Anaesth 42, 891–903 (1995). https://doi.org/10.1007/BF03011037

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