The spinal application of opiates is followed by a long-lasting and strong pain relief. This action is based upon the binding of opiates to specific opiate receptors situated in the substantia gelatinosa of the spinal cord. Two possible approaches exist - intrathecally or epidurally. The intrathecal opiate analgesia is combined with a very high incidence of side effects, so that this way cannot be recommended. The epidural opiate analgesia has proven good results with few side effects in the treatment of postoperative pain, pain of multiple rib fractures and other thoracic trauma or cancer pain. In obstetrics analgesia by spinal opiates was disappointing. Mode of action, possible side effects and the results of epidural opiates are discussed.
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