[Treatment of postoperative pain with peridural administration of opioids]

The advantages and disadvantages associated with epidural opioids require careful selection of the opioid and its dose regimen. There is no ideal opioid available for epidural use. Comparative pharmacokinetic data help selection of the appropriate epidural opioid. Morphine (provided it is given in small doses and volumes) is very appropriate for epidural pain treatment, especially for longer periods of treatment, due to the excellent analgesia and very low systemic morphine concentrations. The faster onset of analgesia makes the epidural application of pethidine, alfentanil and fentanyl recommendable. However, due to the increased risk of respiratory depression during continuous treatment, these opioids should not be given over longer treatment periods. Epidural administration of methadon, sufentanil and buprenorphine cannot be recommended since the advantages over systemic use do not outweigh the risks. Epidural tramadol is useful in clinical routine if opioids are not available and supervision of the patient is not guaranteed, because the opioid is not restricted by law and has a low potential for central depressive effects. Nalbuphine and butorphanol should not be selected for epidural use until the benefit/risk ratio is defined. The safety of patients is paramount. If patients are harmed by inappropriate opioids or dose regimens, this will unjustly discredit a valuable treatment of postoperative pain.