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  • Print publication year: 2009
  • Online publication date: October 2009

8 - Pharmacokinetics of Epidural Opioids

from SECTION I - Pain Physiology and Pharmacology


1. Basbaum AI, Jessell TM. The Perception of Pain. In: Kandel ER, Schwartz JH, Jessell TM, eds. Principles of Neural Science. 4th ed. New York, NY: McGraw-Hill; 2000:472–479.
2. Leon-Casasola OA, Lema MJ. Postoperative epidural opioid analgesia: what are the choices? Anesth Analg. 1996;83:867–875.
3. Robinson DA, Calejesan AA, Wei F, Gebhart GF, Zhuo M. Endogenous facilitation: from molecular mechanisms to persistent pain. Curr Neurovasc Res. 2004;1:11–20.
4. Jensen TS. Opioids in the brain: supraspinal mechanisms in pain control. Acta Anaesthesiol Scand. 1997;41:123–132.
5. Ready LB. Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med. 1999;24:499–505.
6. Guinard JP, Mavrocordatos P, Chiolero R, Carpenter RL. A randomized comparison of intravenous versus lumbar and thoracic epidural fentanyl for analgesia after thoracotomy. Anesthesiology. 1992;77:1108–1115.
7. Loper KA, Ready LB, Downey M, et al. Epidural and intravenous fentanyl infusions are clinically equivalent after knee surgery. Anesth Analg. 1990;70:72–75.
8. Miguel R, Barlow I, Morrell M, et al. A prospective, randomized, double-blind comparison of epidural and intravenous sufentanil infusions. Anesthesiology. 1994;81:346–352.
9. Coda BA, Brown MC, Risler L, Syrjala K, Shen DD. Equivalent analgesia and side effects during epidural and pharmacokinetically tailored intravenous infusion with matching plasma alfentanil concentration. Anesthesiology. 1999;90:98–108.
10. Quencer RM, Post MJ, Hinks RS. Cine MR in the evaluation of normal and abnormal CSF flow: intracranial and intraspinal studies. Neuroradiology. 1990;32:371–391.
11. Enzmann DR, Pelc NJ. Normal flow patterns of intracranial and spinal cerebrospinal fluid defined with phase-contrast cine MR imaging. Radiology. 1991;178:467–474.
12. Nordberg G, Hedner T, Mellstrand T, Dahlstrom B. Pharmacokinetic aspects of epidural morphine analgesia. Anesthesiology. 1983;58:545–551.
13. Gourlay GK, Cherry DA, Cousins MJ. Cephalad migration of morphine in CSF following lumbar epidural administration in patients with cancer pain. Pain. 1985;23:317–326.
14. Burm AG, Haak-van der Lely F, van Kleef JW, et al. Pharmacokinetics of alfentanil after epidural administration: investigation of systemic absorption kinetics with a stable isotope method. Anesthesiology. 1994;81:308–315.
15. van den Nieuwenhuyzen MC, Stienstra R, Burm AG, Vletter AA, van Kleef JW. Alfentanil as an adjuvant to epidural bupivacaine in the management of postoperative pain after laparotomies: lack of evidence of spinal action. Anesth Analg. 1998;86:574–578.
16. Scott DA, Blake D, Buckland M, et al. A comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 microg/mL fentanyl for seventy-two hours of postoperative analgesia after major abdominal surgery. Anesth Analg. 1999;88:857–864.
17. Liu SS, Allen HW, Olsson GL. Patient-controlled epidural analgesia with bupivacaine and fentanyl on hospital wards: prospective experience with 1,030 surgical patients. Anesthesiology. 1998;88:688–695.
18. Guinard JP, Carpenter RL, Chassot PG. Epidural and intravenous fentanyl produce equivalent effects during major surgery. Anesthesiology. 1995;82:377–382.
19. Joris JL, Jacob EA, Sessler DI, et al. Spinal mechanisms contribute to analgesia produced by epidural sufentanil combined with bupivacaine for postoperative analgesia. Anesth Analg. 2003;97:1446–1451.
20. Menigaux C, Guignard B, Fletcher D, et al. More epidural than intravenous sufentanil is required to provide comparable postoperative pain relief. Anesth Analg. 2001;93:472–476, 474th contents page.
21. Gambling D, Hughes T, Gould EM, Manvelian G. A pharmacokinetic and phamacodynamic study of a single dose of epidural DepoDur following epidural bupivacaine: a randomized controlled trial in patients undergoing lower abdominal surgery. Paper presented at: American Society of Regional Anesthesia and Pain Medicine, 2006; Rancho Mirage, CA.
22. Viscusi ER, Martin G, Hartrick CT, Singla N, Manvelian G. Forty-eight hours of postoperative pain relief after total hip arthroplasty with a novel, extended-release epidural morphine formulation. Anesthesiology. 2005;102:1014–1022.
23. Carvalho B, Riley E, Cohen SE, et al. Single-dose, sustained-release epidural morphine in the management of postoperative pain after elective cesarean delivery: results of a multicenter randomized controlled study. Anesth Analg. 2005;100:1150–1158.
24. Bernards CM, Shen DD, Sterling ES, et al. Epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidural opioids (part 1): differences among opioids. Anesthesiology. 2003;99:455–465.
25. Angst MS, Ramaswamy B, Riley ET, Stanski DR. Lumbar epidural morphine in humans and supraspinal analgesia to experimental heat pain. Anesthesiology. 2000;92:312–324.
26. Chauvin M, Hongnat JM, Mourgeon E, et al. Equivalence of postoperative analgesia with patient-controlled intravenous or epidural alfentanil. Anesth Analg. 1993;76:1251–1258.
27. van den Nieuwenhuyzen MC, Burm AG, Vletter AA, Stienstra R, van Kleef JW. Epidural vs. intravenous infusion of alfentanil in the management of postoperative pain following laparotomies. Acta Anaesthesiol Scand. 1996;40:1112–1118.
28. Sandler AN, Stringer D, Panos L, et al. A randomized, double-blind comparison of lumbar epidural and intravenous fentanyl infusions for postthoracotomy pain relief. Analgesic, pharmacokinetic, and respiratory effects. Anesthesiology. 1992;77:626–634.
29. Miguel R, Barlow I, Morrell M, et al. A prospective, randomized, double-blind comparison of epidural and intravenous sufentanil infusions. Anesthesiology. 1994;81:346–352.
30. Lanz E, Theiss D, Riess W, Sommer U. Epidural morphine for postoperative analgesia: a double-blind study. Anesth Analg. 1982;61:236–240.
31. Gambling D, Hughes T, Martin G, Horton W, Manvelian G. A comparison of Depodur, a novel, single-dose extended-release epidural morphine, with standard epidural morphine for pain relief after lower abdominal surgery. Anesth Analg. 2005;100:1065–1074.
32. Hartrick CT, Martin G, Kantor G, Koncelik J, Manvelian G. Evaluation of a single-dose, extended-release epidural morphine formulation for pain after knee arthroplasty. J Bone Joint Surg Am. 2006;88:273–281.