Lecron L, Toppet-Balatoni E, Bogaerts J
Anesth Analg (Paris). 1980;37(9-10):549-56.
Various methods of medullary analgesia are suggested using either the peridural or the subarachnoid technique. Spinal analgesia is much in demand in anaesthesia, in post-operative care or for the alleviation of chronic, mainly neoplastic, pain. Anaesthesia is obtained with a local anaesthetic acting at the level of the membrane. The adjunction of an opiate, acting at the level of the medullary morphinic receptors, enhances local anaesthesia both in depth and duration. This association allows lesser concentrations and volumes of drugs to be used. Various opiates have been tested: their effect depends on the type of administration (I. V., intra-medullary). In the case of intra-medullary injection these is also a difference in the action of the drug according to the technique used (peridural or subarachnoid). The meningeal barrier plays a major function, preventing the diffusion and fixation on the morphinic receptors of some drugs administered peridurally. The action of these drugs, when injected by the subarachnoid technique, is enhanced; this is the case of morphine-base. Others according to their physicochemical characteristics cross easily the dura mater and are very active when injected peridurally. Opiates are also used for the alleviation of chronic pain and are quite as effective as local anaesthetics, steroids or hypertonic saline by peridural injection. The main interest of these techniques lies in the easy reversibility of the analgesia.
有人提出了多种使用硬膜外或蛛网膜下技术的髓质镇痛方法。脊髓镇痛在麻醉、术后护理或缓解慢性疼痛（主要是肿瘤性疼痛）方面有很大需求。通过作用于脑脊膜水平的局部麻醉药可实现麻醉。在髓质吗啡受体水平起作用的阿片类药物的辅助使用，可增强局部麻醉的深度和持续时间。这种联合使用允许使用更低浓度和更少体积的药物。人们已经测试了多种阿片类药物：它们的效果取决于给药方式（静脉注射、髓内注射）。在髓内注射的情况下，根据所使用的技术（硬膜外或蛛网膜下），药物的作用也存在差异。脑脊膜屏障起着主要作用，可防止硬膜外给药的某些药物扩散并固定在吗啡受体上。当通过蛛网膜下技术注射这些药物时，其作用会增强；吗啡碱就是这种情况。其他药物根据其理化特性很容易穿过硬脑膜，硬膜外注射时非常有效。阿片类药物也用于缓解慢性疼痛，并且通过硬膜外注射与局部麻醉药、类固醇或高渗盐水一样有效。这些技术的主要优点在于镇痛作用易于逆转。
