Serum Levels following Epidural Administration of Morphine and Correlation with Relief of Postsurgical Pain

Weddel, S. J.; Ritter, Richard R.

doi:10.1097/00132586-198202000-00056

Cited by 19 publications

(30 citation statements)

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“…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). It may be, therefore, that absorption of drugs from the extradural space is altered during or soon after pregnancy (5).…”

Section: Discussioncontrasting

confidence: 57%

“…Vascular removal of local anesthetics from the extradural site can be reduced by agents that produce local vasoconstriction (1,7). For extradural opiates, uptake of drug into the systemic circulation is similar to that after intramuscular administration (14), and will produce some supraspinal analgesia. However, to give selective spinal analgesia opiates must cross the dura mater (2,3).…”

Section: Discussionmentioning

confidence: 99%

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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: 57%

Section: Discussionmentioning

confidence: 99%

Epinephrine Reduces Systemic Absorption of Extradural Diacetylmorphine

Jamous

Hand

Moore

et al. 1986

Anesthesia & Analgesia

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“…Caudal epidural administration of 0.02mg kg -1 alfentanil and 0.08mg kg -1 butorphanol in horses did not produce analgesic effects, behavioral or cardiovascular changes (NATALINI & ROBINSON, 2000). Epidurally administered opioids may spread within the epidural space, may be taken up into the epidural vasculature, may transfer to the subarachnoid space, and may be taken up into the epidural fat (COUSIN & MATHER, 1984;WEDDEL & RITTER, 1981;BERNARDS & HILL, 1990). Epidural opioid analgesia requires diffusion from the site of injection to the opioid receptors of the spinal cord dorsal horn.…”

Section: Introductionmentioning

confidence: 99%

“…Studies in humans and horses have shown that both lipid soluble and hydrophilic opioids such as alfentanil and morphine rapidly produce high plasma concentration after epidural injection (BERNARDS & HILL, 1990;CODA et al, 1999). Although analgesic effects of alfentanil correlate well with plasma levels, analgesic effects of epidural morphine correlated very poorly with plasma concentrations (CODA et al, 1999;TAMSE N et al, 1983;CHAUVIN et al, 1981;DAHLSTROM et al,1982;RAWAL et al, 1981;WEDDEL & RITTER, 1981).…”

Section: Introductionmentioning

confidence: 99%

Plasma and cerebrospinal fluid alfentanil, butorphanol, and morphine concentrations following caudal epidural administration in horses

Natalini

2006

Cienc. Rural

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“…In these conditions, analgesia is sometimes prolonged (3)(4)(5) and may be partly due to the local action of morphine on neuronal pathways in the substantia gelatinosa (6,7). It is possible that effective analgesia may be further prolonged by the extradural administration of a slow release preparation of morphine, from which the drug can slowly diffuse to its presumed site of action.…”

Section: Introductionmentioning

confidence: 99%

Prolonged Release Extradural Morphine

Howard

Murray

Calvey

et al. 1986

Survey of Anesthesiology

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SummaryThe effects of extradural administration of a microcrystalline preparation of morphine (Duromorph) were studied in 5 patients with postoperative or malignant pain. As assessed by pain scores on a visual analogue scale, the effects of the analgesic were extremely variable; the best results were obtained in patients with postoperative pain. Two patients with chronic pain due to malignant disease developed slow respiratory rates. The plasma concentration of morphine usually followed a biphasic pattern; an initial peak between 0.5 and 1.5 hours was succeeded by a second, large peak between 6 and 12 hours. There was little or no apparent relation between the plasma concentration of morphine and the relief ofpain, suggesting that Duromorph may have a local effect on the spinal cord.

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Serum Levels following Epidural Administration of Morphine and Correlation with Relief of Postsurgical Pain

Cited by 19 publications

References 0 publications

Epinephrine Reduces Systemic Absorption of Extradural Diacetylmorphine

Epinephrine Reduces Systemic Absorption of Extradural Diacetylmorphine

Plasma and cerebrospinal fluid alfentanil, butorphanol, and morphine concentrations following caudal epidural administration in horses

Prolonged Release Extradural Morphine

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