Lipid soluble opioids do move in cerebrospinal fluid

Eisenach, James C.

doi:10.1053/rapm.2001.22255

Cited by 8 publications

(3 citation statements)

References 9 publications

(6 reference statements)

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“…This distribution of opioid within the CSF could explain the clinically significant effects, such as respiratory depression, that occur immediately after lumbar spinal injection. 19 Intraoperative shoulder tip pain control is an important factor affecting the successful performance of TEP under regional anaesthesia when a pneumoperitoneal tear occurs. 7 In the present study, shoulder tip pain, regardless of the occurrence of pneumoperitoneum, was easily managed with intravenous ketamine and fentanyl.…”

Section: Discussionmentioning

confidence: 99%

Clinical effects of intrathecal fentanyl on shoulder tip pain in laparoscopic total extraperitoneal inguinal hernia repair under spinal anaesthesia: A double-blind, prospective, randomized controlled trial

et al. 2013

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Objective: The study evaluated the clinical intraoperative effects of intrathecal administration of fentanyl on shoulder tip pain in patients undergoing laparoscopic total extraperitoneal inguinal hernia repair (TEP) under spinal anaesthesia. Methods: Patients undergoing TEP were allocated in a double-blinded, prospective, randomized manner to two groups. Spinal anaesthesia was induced by intrathecal administration of 2.8 ml of 0.5% hyperbaric bupivacaine (14 mg) in the control group and with 2.6 ml of 0.5% hyperbaric bupivacaine (13 mg) and 10 mg fentanyl (0.2 ml) in the experimental group.Results: The quality of muscle relaxation, adequacy of operative space and incidence of pneumoperitoneum were similar in the two groups (n ¼ 36 per group). Compared with the control group, the experimental group had significantly fewer cases of hypotension (12 [

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Section: Discussionmentioning

confidence: 99%

Clinical effects of intrathecal fentanyl on shoulder tip pain in laparoscopic total extraperitoneal inguinal hernia repair under spinal anaesthesia: A double-blind, prospective, randomized controlled trial

et al. 2013

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“…Lipophilic opioids such as fentanyl have a narrow band of analgesia, even though the duration of pain relief is short. The analgesic band is limited to the lumbar dermatomes, so respiratory depression occurs less often [ 16 ]. However, hydrophilic opioids such as morphine possess a broad band of analgesia and have a slow onset with the pain-relieving duration of analgesia persisting for 18 to 24 hours, which is also the typical time span of monitoring after intrathecal morphine.…”

Section: Discussionmentioning

confidence: 99%

The effects of adjuvant intrathecal fentanyl on postoperative pain and rebound pain for anorectal surgery under saddle anesthesia

Shim

Park

Hyun

et al. 2018

Korean J Anesthesiol

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BackgroundIntrathecal opioid has been known to enhance the quality and prolong the duration of spinal anesthesia, as well as to reduce postoperative pain. The purpose of this study was to evaluate postoperative analgesic characteristics of intrathecal fentanyl for the first 48 hours after anorectal surgery under saddle anesthesia.MethodsEighty patients were recruited in our study. Forty patients were randomly allocated to group B that received 0.5% bupivacaine 5 mg with 0.3 ml normal saline. The other 40 patients were assigned to group BF which was given 0.5% bupivacaine 5 mg with fentanyl 15 μg. The primary outcome variable was a numeric rating scale (NRS) at six hours postoperatively. Secondary outcomes included changes in the NRS score between one and 48 hours postoperatively, consumption of rescue analgesics, and the frequency of rebound pain.ResultsGroup BF exhibited a lower mean NRS score at postoperative six hours compared to group B (P < 0.001). However, the mean NRS score was not different after postoperative six hours between the two groups. The median consumption of rescue analgesics in group BF was less than that of group B (P = 0.028) and the frequency of rebound pain decreased in group BF when compared to group B (P = 0.021). The levels of sensory block were S1 dermatome and motor block scores were 0 for both groups. There was no significant difference in adverse effects between the groups.ConclusionsIntrathecal fentanyl 15 μg for anorectal surgery under saddle anesthesia led to an improved pain score for the first six hours after surgery and decreased postoperative analgesic use. Rebound pain diminished with intrathecal fentanyl and adverse effects did not increase.

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“…23,36,44 Morphine has relatively low liposolubility compared with other opioids. 45 While all opioids migrate within the CSF and the neural tissue, lipophilic opioids are expected to display a narrower band of spinal analgesia than hydrophilic ones. Morphine is therefore more likely to lose its anatomical specificity shortly after IT injection.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive technique for intrathecal administration of morphine in rats: practicality and antinociceptive properties

et al. 2016

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The intrathecal (IT) route of administration represents a means to reduce the dose of morphine administered for analgesia, potentially minimizing interactions between opioid effects and experimental outcomes. Perceived technical difficulty, and previously described invasive methods, may limit its use. This report describes a minimally invasive technique for IT administration of morphine by direct transcutaneous lumbosacral puncture in rats; and assesses antinociceptive properties of morphine in anaesthetized rats. Rats ( n = 28) anaesthetized with sevoflurane (inspired fraction of sevoflurane: FSevo = 2.4%) were randomly allocated to receive: IT morphine (0.2 mg/kg); subcutaneous (SC) morphine (3 mg/kg); SC buprenorphine (0.05 mg/kg); or SC or IT sodium chloride (NaCl). After a wash-in period (40 min), thermal nociceptive stimuli were applied at nine locations corresponding to different rostrocaudal dermatomes of the rat. Nociceptive stimulation cycles were repeated at all locations after successive decrement of FSevo by 15%. Presence or absence of gross purposeful movement (GPM) was recorded for each individual stimulation. IT injection of morphine by direct puncture with a 25 G hypodermic needle is easily performed (successful first attempt: 82%) without complications. IT morphine reduced the frequency of GPM following nociceptive thermal stimulation in a way comparable with SC buprenorphine or morphine. It was not possible to delimit any rostral spinal spread of morphine. This report describes a refined and effective technique of administering morphine IT in rats using readily available materials. IT doses being markedly smaller than the systemic equivalent, analgesia could be provided whilst minimizing the potential interactions of non-analgesic opioid effects with research protocols.

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Lipid soluble opioids do move in cerebrospinal fluid

Cited by 8 publications

References 9 publications

Clinical effects of intrathecal fentanyl on shoulder tip pain in laparoscopic total extraperitoneal inguinal hernia repair under spinal anaesthesia: A double-blind, prospective, randomized controlled trial

Clinical effects of intrathecal fentanyl on shoulder tip pain in laparoscopic total extraperitoneal inguinal hernia repair under spinal anaesthesia: A double-blind, prospective, randomized controlled trial

The effects of adjuvant intrathecal fentanyl on postoperative pain and rebound pain for anorectal surgery under saddle anesthesia

Minimally invasive technique for intrathecal administration of morphine in rats: practicality and antinociceptive properties

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