Pain Relief and Plasma Concentrations from Epidural and Intramuscular Morphine in Post-Cesarean Patients

Youngstrom, Paul C.; Cowan, Ronald I; Sutheimer, Craig A.; Eastwood, D. W.; Yu, Jiao; Cheek, Theodore G.; Gutsche, Brett B.

doi:10.1097/00132586-198312000-00034

Cited by 3 publications

(5 citation statements)

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“…However, in the latter study, the time to peak plasma morphine concentration after extradural administration was about 21 min, which contrasts with other mean values of 7 min (9), 5-15 rnin (9,14,16), and 13 min (6,17). It may be, therefore, that absorption of drugs from the extradural space is altered during or soon after pregnancy (5).…”

Section: Discussioncontrasting

confidence: 66%

“…Although reduced peak plasma morphine values and delayed absorption after epinephrine have been reported in volunteers (7), other investigators found no kinetic differences after cesarian section (5). However, in the latter study, the time to peak plasma morphine concentration after extradural administration was about 21 min, which contrasts with other mean values of 7 min (9), 5-15 rnin (9,14,16), and 13 min (6,17).…”

Section: Discussioncontrasting

confidence: 63%

“…SEM) were 179 ? 37 nrnollL with diacetylinorphine alone, 87 5 16 nniollL with diacetylmorphine and epinephrine given together and 44 5 11 nmoll L with epinephrine pretreatnzent, all significantly different from one another. The nreair peak plasma morphine concentration was 8.7 ?…”

mentioning

confidence: 82%

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Epinephrine Reduces Systemic Absorption of Extradural Diacetylmorphine

Jamous

Hand

Moore

et al. 1986

Anesthesia & Analgesia

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HJ. Epinephrine reduces systemic absorption of extradural diacetylmorphine. Anesth Analg 1986;65:1290-4.The effect of epinephriiie on the vascular absorption of morphine froin the extradural space is uncertain; this study examined the effect of epinephrine on the related but more lipophilic opiate diacetylmorphine (diamorphine, heroin) because any effects of vasoconstriction on diacetylmorphirze absorption should be maxirnally apparent. With this experiment, we hoped to resolve whether epinephrine does or does not alter vascular absorption of extradurally injected opiates. Thirty patierits undergoing lumbar laminectomy were given either extradural diacetylmorphine, 5 mg, extradural diacetylmorphine, 5 mg with 2 :200,000 epinephrine, or 1 :200,000 epinephrine followed 5 min later by 5 mg extradural diacetylmorphine. Plasma morphine concentrations were nreasured by radioimmunoassay because of the rapid conversion ofdiacetylmorphine to morphine in plasma; repeated blood sainples were obtained the first 30 nzin after injection into the epidural space. Significantly lower plasmn morphine levels occurred between 3 and 20 min when epinephrine was added to diacetylmorphine. Peak plasma morphine levels (mean ? SEM) were 179 ? 37 nrnollL with diacetylinorphine alone, 87 5 16 nniollL with diacetylmorphine and epinephrine given together and 44 5 11 nmoll L with epinephrine pretreatnzent, all significantly different from one another. The nreair peak plasma morphine concentration was 8.7 ? 1.1 inin for diacetylmorphirzealone, but addition of epinephrine (together or sequentially) rneant that 25 of 20 patients had no peak level before 120 rnin. Epinephrine reduced absorption of diacetylmorphine from the extradural site by at least 55% over the first 30 min. The incidence of patients with more than 9 hr analgesic duration was significantly ( P = 0.033) greater in patients who had diacet!ylmorphine and epinephrine. The use of diacetylmorphine as a model for lipophilic opiates showed that addition of epinephrine not only reduced systemic absorption but also increased analgesic duration. The addition of epinephrine to similarly lipophilic opiates should have the same clinically desirable consequence.

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Section: Discussioncontrasting

confidence: 66%

Section: Discussioncontrasting

confidence: 63%

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Epinephrine Reduces Systemic Absorption of Extradural Diacetylmorphine

Jamous

Hand

Moore

et al. 1986

Anesthesia & Analgesia

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“…Bu arada anne ve yeni doğan verilen ilaçların yan etkilerinden korunmalıdır. Sezaryen sonrası analjezi için çalışılmış pek çok ilaç ve teknikler vardır [3][4][5][6][7][8] . Tramadol ve meperidin bu amaçla kullanılan ilaçlardan olup, postoperatif ağrı tedavisi için intramusküler kullanımda etkinlikleri gösterilmiş ilaçlardır [9][10] .…”

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Comparison of meperidine and tramadol in postoperative pain management following elective cesarean births: A prospective randomized study

Hüseyınoğlu¹,

Ülker²,

Temur³

et al. 2011

Kafkas J Med Sci

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“…Tableau 1 Pharmacocinétique paracétamol d'après Spigset et Hagg[15] La résorption sanguine, après administration en périmédul-laire, est à l'origine d'un passage lacté bien inférieur :• par voie spinale : un cas clinique rapportant les taux sanguins et lactés de morphine chez une patiente bénéfi-ciant d'une administration continue intrathécale de fortes doses de morphine durant sept semaines relate qu'il n'a pu être mis en évidence de passage systémique ou lacté significatif[36] ;• par voie péridurale : Youngstrom et al[37] ont comparé l'administration de 4 mg de morphine par voie intramusculaire et péridurale pour analgésie postcésarienne. Outre la supériorité analgésique de l'administration péridurale de la morphine, ils ont relevé des pics plasmatiques moindres de moitié (24,8 vs 12,5 ng/ml) dans le groupe péri-dural.…”

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