Which of the following opioids is not given intrathecally?
Core concept here is the pharmacological properties of opioids regarding their lipid solubility and molecular size, which determine if they can cross the meninges when given intrathecally. Only certain opioids are suitable because they need to act locally in the spinal fluid without causing toxicity.
The correct answer is likely an opioid that's too large or not lipid-soluble enough. Let me think. Fentanyl, sufentanil, morphine, and buprenorphine are commonly used intrathecally. Hydromorphone is another one. But maybe meperidine (pethidine) isn't? Wait, meperidine has been associated with neurotoxicity when given intrathecally, so it's not used. Or maybe it's because of its high lipid solubility leading to rapid diffusion and unpredictable effects. Alternatively, maybe the question is about a specific opioid that's contraindicated.
Wait, the options weren't provided, so I need to make educated guesses. Let's assume the options include morphine, fentanyl, meperidine, and hydromorphone. The correct answer would be meperidine. Because meperidine is not given intrathecally due to its potential to cause seizures when administered via this route. Its metabolite, normeperidine, is neurotoxic, especially in the CNS, which is why it's contraindicated for intrathecal use.
For the wrong options: Morphine is a classic intrathecal opioid, used for post-op pain. Fentanyl is lipid-soluble and can be used intrathecally. Hydromorphone is also used, maybe more potent. So, if the options include these, the correct answer is meperidine.
Clinical pearl: Remember that meperidine is contraindicated intrathecally due to neurotoxicity. High-yield fact: only certain opioids are safe for intrathecal administration because of their pharmacokinetic profiles.
**Core Concept**
Intrathecal opioid administration requires drugs with appropriate lipid solubility and molecular size to cross the meninges and act centrally. Opioids like morphine, fentanyl, and hydromorphone are commonly used, while others may be excluded due to toxicity or pharmacokinetic limitations.
**Why the Correct Answer is Right**
**Meperidine (pethidine)** is contraindicated for intrathecal use due to its metabolite **normeperidine**, a central nervous system (CNS) stimulant that causes seizures. Its high lipid solubility also leads to rapid diffusion from the cerebrospinal fluid (CSF), reducing efficacy and increasing systemic toxicity risk. Unlike other opioids, meperidine’s neurotoxic profile makes it unsuitable for spinal administration.
**Why Each Wrong Option is Incorrect**
**Option A: Morphine** – Frequently used intrathecally for postoperative analgesia; its low lipid solubility allows prolonged CSF residence.
**Option B: Fentanyl**