Spinal Opiate Analgesia Experimental and Clinical Studies
The recent development of the use of spinal opiates as a rational therapy for pain rests on clear and certain experimental data. We have long known the spinal cord to be a highly complex structure. Anatomical studies of the substantia gelatinosa have repe
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Anaesthesiologie und Intensivmedizin Anaesthesiology and Intensive Care Medicine
Herausgeber: H. Bergmann' Linz (Schriftleiter) lB. Bruckner· Berlin R. Frey t· Mainz M. Gemperle . Geneve W.P. Henschel' Bremen O. Mayrhofer . Wien K. Peter' Miinchen
Spinal Opiate Analgesia Experimental and Clinical Studies Edited by T.L. Yaksh and H. Muller
With 55 Figures and 54 Tables
Springer-Verlag Berlin Heidelberg New York 1982
Tony L. Yaksh, MD Depts. of Neurologic Surgery and Pharmacology Mayo Foundation Rochester, MN 55905 USA Dr. med. Hermann MUller Dept of Anesthesiology and Intensive Care Medicine Justus Liebig University Klinikstr.29 0-6300 Giessen Federal Republic of Germany
ISBN-13: 978-3-540-11036-1 e-ISBN-13: 978-3-642-68261-2 DOl: 10.1007/978-3-642-68261-2 Library of Congress Cataloging in Publication Data Main entry under title: Spinal opiate analgesia. (Anaesthesiologie und Intensivmedizin; 144) Bibliography: p. Includes index. 1. Spinal anesthesia. 2. Narcotics- -Physiological effect. I. Yaksh, T.L. . II. Miiller, H. (Hermann) III. Series [DNLM: (Tony L.), 19441. Anesthesia, Spinal. 2. Narcotics- -Therapeutic use. 3. Pain, Intractable-Drug therapy. 4. Pain, Postoperative- -Drug therapy. WI AN103YJ v. 144/ QV90 S757) RD85.S7S64 615'.783 81-18466 ISBN-13: 978-3-540-11036-1 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned specifically those of translation, reprint· ing, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. Under § 54 of the German Copyright Law where copies are made for other than private use a fee is payable to "Verwertungsgesellschaft Wort", Munich. © Springer-Verlag Berlin Heidelberg 1982
The use of registered names, trademarks etc. in this publication does not imply even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Typesetting: Schreibsatz Service Weihrauch, Wiirzburg Printing and binding: Offsetdruckerei Julius Beltz KG, Hemsbach 2127/3321-543210
Preface
The recent development of the use of spinal opiates as a rational therapy for pain rests on clear and certain experimental data. We have long known the spinal cord to be a highly complex structure. Anatomical studies of the substantia gelatinosa have repeatedly demonstrated signs of massive synaptic interaction between primary afferents, descending pathways and intrinsic neurons. Yet, to date that knowledge, insofar as clinical therapy is concerned, has permitted us only to destroy certain connections within the spinal cord in the hopes that the substrate mediating pain could be anatomically differentiated from those which mediate other function. Though cordotomies are clearly effective under certain circumstances, they suffer from the fact the spinal cord is not organized in such an anatomically discrete fashion as is often times drawn in basic medical text. Rather, functions intertwine exquisit
