Sufentanil Concentrations in the Spinal Cord After Long Term Epidural Infusion

Boersma, F. P.; Noorduin, H.; Pieters, Willem; Woestenborgg, R.; Eng, Chan; Heykants, J.

doi:10.1097/00000542-198909001-00706

Cited by 10 publications

(14 citation statements)

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“…The administration of epidural opioids for the management of postoperative pain is well established, however the optimal opioid for epidural administration has not been established. Partition of lipid soluble opioids into the epidural fat and spinal cord white matter prevents the drug from reaching the spinal cord gray matter where the majority of pain receptors are located ( 1). Lipophilic drugs have decreased side‐effects and a reduced risk of delayed respiratory depression but their action is limited to segmental distribution.…”

Section: Introductionmentioning

confidence: 99%

“…administration has not been established. Partition of lipid soluble opioids into the epidural fat and spinal The administration of epidural opioids for the cord white matter prevents the drug from reaching management of postoperative pain is well the spinal cord gray matter where the majority of established, however the optimal opioid for epidural pain receptors are located (1). Lipophilic drugs have decreased side-effects and a reduced risk of delayed respiratory depression but their action is limited opioids are associated with better analgesia that is consent was obtained from all parents.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery

Goodarzi

1999

Pediatric Anesthesia

113

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The safety and side-effects profile of epidural administration of a hydrophilic (morphine), highly lipophilic (fentanyl) and a drug with intermediate hydrophilic and lipophilic activity (hydromorphone) were compared in 90 children undergoing orthopaedic procedures. Ninety patients were randomly assigned (30 in each group) to receive epidural morphine, hydromorphone, or fentanyl for postoperative analgesia. Respiratory effects, nausea, somnolence, urinary retention, pruritus and visual pain scales were evaluated and compared during a 30-h period following surgery. In the morphine group, 25% showed respiratory depression with oxygen saturation below 90% but there was no incidence of respiratory depression in the fentanyl or hydromorphone groups. Somnolence was prominent in some of the patients in all the groups, but was more prolonged in the morphine group. Statistically, there was no significant difference in nausea between the groups, but pruritus was more severe and frequent in the morphine group. The incidence of urinary retention in the morphine group was higher compared with the fentanyl and hydromorphone groups. In conclusion, epidural hydromorphone, demonstrating less side-effects, is preferable to morphine and fentanyl for epidural analgesia in children.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery

Goodarzi

1999

Pediatric Anesthesia

113

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“…Administered in the epidural space, a highly lipophilic drug such as sufentanil has a fast onset with a peak effect between 5 and 15 minutes, whereas the peak effect of morphine, a hydrophilic drug, is reached after one hour. Lipid solubility would also explain the low rostral spread of sufentanil and possibly explain the lower incidence of side effects [11]. However, lipid solubility also produces early onset of respiratory depression after epidural administration due to rapid systemic uptake.…”

Section: Physical and Chemical Properties Of Spinal Opioidsmentioning

confidence: 99%

Long-Term Spinal Opioid Therapy in Terminally Ill Cancer Pain Patients

1997

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In terminally ill cancer patients with refractory pain, long-term spinal opioid therapy may provide a profound analgesia with minimal side effects. The reversibility of the technique and its efficacy throughout the body and for different types of pain are important advantages. For epidural administration, it is preferable to use lipid soluble opioids (sufentanil). For intrathecal administration, morphine is the best choice. The advantages of intrathecal administration over epidural administration are the need for lower doses because of a more direct administration at the receptor site, the easy positioning of the catheter, and less risk for migration of the catheter. In severe refractory pain which does not respond to spinal opioids, the use of nonopioids (e.g., a local anesthetic or an alpha-2 adrenoreceptor agonist) as coanalgesics may be recommended for improving pain relief. Long-term spinal opioid therapy at home has been made possible by technical and organizational development. In home care, only one physician should be the manager for the patient. Coordination should be optimized among patient, family, general practitioner, oncologist, anesthesiologist, home nurse, technician, and pharmacist.

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“…One can find evidence for this logical order of things: when sufentanil is administered epidurally over long periods of time in humans, most of the drug is found in the epidural fat, some is in the spinal cord white matter, and almost none in the spinal cord gray matter. 2 On the other hand, intrathecal injection of a bolus, as used for analgesia in labor or anesthesia in the operating room, is not an equilibrium condition like prolonged infusion, and drug disposition likely differs after a bolus compared to a chronic infusion.…”

mentioning

confidence: 99%

Lipid soluble opioids do move in cerebrospinal fluid

Eisenach

2001

Regional Anesthesia and Pain Medicine

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Sufentanil Concentrations in the Spinal Cord After Long Term Epidural Infusion

Cited by 10 publications

References 0 publications

Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery

Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery

Long-Term Spinal Opioid Therapy in Terminally Ill Cancer Pain Patients

Lipid soluble opioids do move in cerebrospinal fluid

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