[Pain treatment by sub or epidural opiate administration]

Morphine and opiate analogues for pain relief were applied epidurally or intrathecally. Synthetic opioids, eg. pethidine, pentazocine or piritramide proved unsuitable with both modes of administration. Only morphine in doses as low as 2 mg reliably produced analgesia lasting from 16-24 hours. Intrathecal application of morphine is of limited value because of the substance's possible transport to medullary regulating centres and therefore is not recommended in awake patients. Conversely this very side effect may advantageously be employed in patients on ventilator treatment as a method for analgesia and sedation. Lumbar epidural administration of single doses of morphine 2 mg at present is the most effective treatment both for pain following thoracotomy, laparotomy, surgery on the vertebral column, gynecological and urological procedures and pain due to trauma to the chest wall or pelvis, provided supervision in an intensive care ward guards against possible side effects. Epidural or intrathecal opiate is not suitable for the treatment of chronic or functional pain.