[How can we improve the efficacy of morphine analgesia without increasing adverse effects?]

The use of opioids for postoperative pain relief is associated with the occurrence of side effects whatever the technique of administration. One may consider different solutions to reduce these side effects, while maintaining an adequate analgesia level. Combination of different pharmacological types of analgesic agents is defined as "balanced analgesia". In this setting, non steroidal antiinflammatory drugs have been demonstrated to reduce opioids requirements during patient-controlled analgesia and to improve the quality of epidural analgesia. Alpha 2 adrenergic agonists, acting at the level of the dorsal horn of the spinal cord, also strengthen and prolong analgesia induced by epidural or spinal opioids. Finally, local anaesthetic solutions in low concentration may potentiate the analgesic effect of opioids, also improving the quality of analgesia. These different combinations have to be considered in view of the surgical procedure performed, the patient condition and the possibilities of monitoring in any given care unit.