Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia

Background and Objectives. Lipophilic opioids, especially fentanyl and sufe ntanil, are increasingly being administered intrathecally as adjuncts to sp inal anesthesia. This review analyzes the efficacy of these opioids for sub arachnoid anesthesia. Methods. Medline search of the literature from 1980 t o the present and a survey of recent meeting abstracts are reviewed. Result s. A significant number of citations regarding intrathecal lipophilic opioi ds as adjuncts to spinal anesthesia were found: 59 are cited in this review . Most clinical experience has been in obstetric surgery, but lipophilic sp inal opioid administration is being used with greater frequency for other s urgical procedures as well. The benefits include reduction of minimal alveo lar concentration (MAC) when general anesthesia is combined with spinal ane sthesia and enhancement of the quality of spinal anesthesia without prolong ation of motor block. Intrathecal fentanyl and sufentanil allow clinicians to use smaller doses of spinal local anesthetic, yet still provide excellen t anesthesia for surgical procedures. Furthermore, lipophilic opioid/local anesthetic combination permits more rapid motor recovery; short outpatient procedures are therefore more amenable to spinal anesthesia. Finally, the s ide-effect profiles of intrathecal lipophilic opioids are now well characte rized and appear less troublesome than intrathecal morphine. Conclusions. T he anesthesia-enhancing properties and side-effect profile of lipophilic op ioids administered intrathecally suggest significant roles for these agents as adjuncts to spinal anesthesia for obstetric and outpatient procedures.