Epidural opioids are widely used in the management of post-operative pain. On the basis of an extensive review of theliterature the authors here present their own interpretationof current knowledge of howthe distribution and effectiveness of epidurallyadministeredopiods are fundamentally determined.They conclude that all opioids that arecurrently being used to treat postoperative epidural paincarry the potential risk of severeside effects if the dose regimens are not tailored to thepatient`s individual analgesic need.This book will serve to stimulate new ideas among painspecialistst.

Epidural and Intrathecal Space

Anatomy
Puncture of the Meninges
Distribution of Solutions
Determinants of Opioid Activity
Physicochemical Properties
Distribution and Elimination
Opioid Receptors
Opioid Pharmacokinetics After Epidural Administration
Transfer Across the Meninges
Uptake into the CSF
Distribution within the CSF
Elimination from CSF
Uptake into Spinal Cord and Brain
Uptake into Epidural Fat
Vascular Uptake into the Systemic Circulation
Elimination from Blood
Summary
Clinical Implications
Onset Time of Analgesia
Duration of Action
Side-Effects
Quality of Analgesia
Summary
Relative Analgesic Potencies
Definition
Quantitation from Postoperative Dose Requirements.
Interpretation
Summary
Risk-Benefit Evaluation
Morphine
Meperidine
Methadone
Alfentanil
Fentanyl
Sufentanil
Buprenorphine
Tramadol
Summary
References.