Postoperative Epidural Opioids Book

	Introduction	1
	Epidural and Intrathecal Space	3
	Anatomy	3
	Puncture of the Meninges	5
	Distribution of Solutions	8
	Determinants of Opioid Activity	9
	Physicochemical Properties	11
	Distribution and Elimination	14
	Opioid Receptors	16
	Supraspinal Receptor Sites	16
	Spinal Receptor Sites	18
	Receptor Affinities	19
	Receptor Binding Kinetics	22
	Opioid Pharmacokinetics After Epidural Administration	25
	Transfer Across the Meninges	25
	Uptake into the CSF	26
	Distribution within the CSF	27
	Elimination from CSF	32
	Uptake into Spinal Cord and Brain	32
	Uptake into Epidural Fat	33
	Vascular Uptake into the Systemic Circulation	34
	Following Epidural Bolus Injections	34
	During Continuous Epidural Opioid Treatment	37
	Elimination from Blood	40
	Clinical Implications	43
	Onset Time of Analgesia	43
	Duration of Action	45
	Injection Volume	53
	Addition of Epinephrine	53
	Side-Effects	54
	Pruritus	55
	Urinary Retention	56
	Early Respiratory Depression	56
	Late Respiratory Depression	57
	Treatment	62
	Quality of Analgesia	62
	Relative to Systemic Opioids	62
	Injection Volume	63
	Addition of Local Anesthetics	64
	The Optimum Dosage Regimen	67
	Relative Analgesic Potencies	73
	Definition	73
	Quantitation from Postoperative Dose Requirements	73
	Interpretation	77
	Risk-Benefit Evaluation	85
	Morphine	85
	Meperidine	87
	Methadone	88
	Alfentanil	89
	Fentanyl	90
	Sufentanil	91
	Buprenorphine	92
	Tramadol	93
	References	97