Survey of intrathecal opioid usage in the UK.
OBJECTIVE
Intrathecal opioids are now used routinely in the UK for intra- and postoperative analgesia. The opioids of choice have altered over recent years and the dosage regimens used can vary between institutions. Concerns over safety have been reduced probably because much lower doses of opioids are now being used. This survey explored the practice of intrathecal opioid usage in the UK.


METHODS
We sent a questionnaire survey to 270 anaesthetic departments and received 199 replies, a response rate of 73.7%.


RESULTS
Intrathecal opioids were used in 175 (88.4%) departments. Of these departments, 107 (61.1%) had local guidelines or protocols in place. Opioids such as diamorphine (used in 136 (78.2%) of departments) and fentanyl (129 (74.1%)) with a shorter duration of action are now more commonly used than morphine (37 (21.3%)) for intrathecal analgesia. In 96 (54.5%) departments, patients were nursed on regular surgical wards following administration of spinal opioids.


CONCLUSIONS
The use of low-dose lipophilic intrathecal opioids for postoperative analgesia is widespread in the UK. Patients are commonly nursed in low-dependency post-anaesthetic care areas. The low incidence of adverse events reported by the respondents along with the popularity of the technique suggests that low-dose spinal opioid administration is safe.
Derby Hospitals NHS Foundation Trust, Department of Critical Care, Derby, UK. marco.giovannelli@derbyhospitals.nhs.uk
M
M
Giovannelli
N
N
Bedforth
A
A
Aitkenhead
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017408:Guidelines as Topic; D019538:Health Care Surveys; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007278:Injections, Spinal / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000517:prevention & control; D011795:Surveys and Questionnaires; D006113:United Kingdom
D000701:Analgesics, Opioid; D003932:Heroin; D005283:Fentanyl