Pharmacokinetic aspects of spinal morphine analgesia

Nordberg, Gunnar F.

doi:10.1111/j.1399-6576.1984.tb02148.x

Cited by 60 publications

(17 citation statements)

References 179 publications

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“…Lumbar epidural injection in humans will deposit the drug in close proximity to the subarachnoid space and consequently it will transfer more quickly from the epidural to the subarachnoid space compared to intercoccygeal injection in horses in our study. It has been reported that increasing volume of the solution does not influence CSF plasma concentrations of morphine in humans (NORBERG et al, 1984;SCHEININ et al, 1986). Data from our study demonstrates that epidurally administered butorphanol is rapidly detected in the plasma similar to findings for alfentanil and morphine and increases significantly in CSF after epidural administration similar to the more lipid soluble opioid alfentanil.…”

Section: Discussionsupporting

confidence: 82%

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

Natalini

2006

Cienc. Rural

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Section: Discussionsupporting

confidence: 82%

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

Natalini

2006

Cienc. Rural

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“…These effects were fully reversible after each injection and are consistent with the effects reported in dogs (Atchison, Durant, and Yaksh 1986;Sabbe et al 1994), and in humans (Nordberg 1984;Payne 1987;Krames 1993) after spinally delivered mu opioid agonists. The onset and duration of action as well as the presumed neuraxial sites where these behavioral effects are mediated suggest the observed effects re ect several mechanisms, some of which are spinal and some of which represent extraspinal redistribution.…”

Section: Physiological and Behavioral Effectssupporting

confidence: 89%

Safety Assessment of Encapsulated Morphine Delivered Epidurally in a Sustained-Release Multivesicular Liposome Preparation in Dogs

et al. 2000

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We have shown that the epidural (EPI) delivery of morphine encapsulated in multivesicular liposomes (DepoFoam drug delivery system) produces a sustained clearance of morphine and a prolonged analgesia. We have sought to subsequently determine the likelihood of deleterious effects on local tissue of repetitive epidural injections of this encapsulated morphine preparation (C0401). Beagle dogs were prepared according to protocol approved by the Institutional Animal Care and Use Committee under volatile general anesthesia with chronic lumbar EPI catheters and subcutaneous injection ports. Male and female dogs (three groups) received a total of 4 EPI injections at 8-day intervals of 3 mL of C0401 (10 mg/mL morphine) (N = 6), DepoFoam vehicle (N = 6), or 0.9% sodium chloride (N = 6). Following EPI-C0401, but not saline or DepoFoam vehicle, there were transient (< 72 hr) decreases in food consumption, arousal, hindlimb muscle tone, and body temperature. Heart rate was unaltered, but there were modest decreases in blood pressure and respiratory rate, which persisted for 24-72 hr after C0401. No persistent changes in sensory/motor function, body weight, or stool/urine production were observed. Cerebrospinal fluid, blood chemistry, and urinalysis performed at surgery and on the day of sacrifice (24 hr after the last dose) were within normal ranges. Gross pathology at necropsy was unremarkable. Spinal histopathology findings were judged to be minimal (e.g., modest pericatheter inflammation and fibrosis) and present in all dogs. However, a statistical trend in the rank order of pathology scores was noted (Saline < DepoFoam vehicle < C0401). Repeated EPI injection of C0401 at the maximum dose that could be administered (30 mg) resulted in moderate, transient behavioral and physiological effects after each injection, consistent with morphine administration, and a modest effect on cord histopathology. This level of pathology is reflected in the lack of change observed in cerebrospinal fluid and lack of neurological findings. These results suggest that C0401 is without significant pathological effects at this dose after repeated epidural delivery in dogs.

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“…The addition of morphine to the anesthetic mixture produced enduring postoperative pain relief, as is usually reported (10,11,12,13). Itching, namely nose and eyelids rubbing, was a general feature in children who were administered epidural preservative-free morphine but also in those who were not.…”

Section: Discussionmentioning

confidence: 94%

Lumbar Epidural Anesthesia for Operative and Postoperative Pain Relief in Infants and Young Children

Dalens¹,

Tanguy²,

Haberer³

1986

Anesthesia & Analgesia

107

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Pharmacokinetic aspects of spinal morphine analgesia

Cited by 60 publications

References 179 publications

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

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

Safety Assessment of Encapsulated Morphine Delivered Epidurally in a Sustained-Release Multivesicular Liposome Preparation in Dogs

Lumbar Epidural Anesthesia for Operative and Postoperative Pain Relief in Infants and Young Children

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