Epidural Lidocaine Alters the Pharmacokinetics and Drug Effects of Extended-Release Epidural Morphine (DepoDur®) After Cesarean Delivery

Obstetric Anesthesia


Anesthesia for Cesarean Delivery


Prior Epidural Lidocaine Alters the Pharmacokinetics and Drug Effects of Extended-Release Epidural Morphine (DepoDur®) After Cesarean Delivery


Atkinson Ralls L, Drover DR, Clavijo CF, et al (Stanford Univ School of Medicine, CA; Univ of Colorado, Denver) Anesth Analg 113:251-258, 2011§



D.H. Chestnut, MD



Evidence Ranking


• A



Expert Rating


• 1



Abstract



Background


A potential physicochemical interaction between epidural local anesthetics and extended-release epidural morphine (EREM) could negate the sustained release. In this study, we sought to determine the pharmacokinetic and drug effects of prior epidural lidocaine administration on EREM.



Methods


Thirty healthy women undergoing cesarean delivery were enrolled in this randomized study. Patients received 8 mg EREM 1 hour after either a combined spinal-epidural (intrathecal bupivacaine and fentanyl 20 μg with no epidural medication; group SE) or an epidural anesthetic (epidural 2% lidocaine with fentanyl 100 μg; group E). Maximal concentration (Cmax), time to Cmax (Tmax), and AUC0–last (area under the concentration-time curve until the last plasma concentration that was below the limit of quantitation) for morphine levels were determined from a plasma sample at 0, 5, 10, 15, and 30 minutes, and 1, 4, 8, 12, 24, 36, 48, and 72 hours. Drug effects including pain, analgesic use, and side effects were measured for 72 hours after cesarean delivery.

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Jan 28, 2017 | Posted by in ANESTHESIA | Comments Off on Epidural Lidocaine Alters the Pharmacokinetics and Drug Effects of Extended-Release Epidural Morphine (DepoDur®) After Cesarean Delivery

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