title: Epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidural opioids (part 2): effect of epinephrine.
abstract: BACKGROUND
  The ability of epinephrine to improve the efficacy of epidurally administered drugs is assumed to result from local vasoconstriction and a consequent decrease in drug clearance. However, because drug concentration in the epidural space has never been measured, our understanding of the effect of epinephrine on epidural pharmacokinetics is incomplete. This study was designed to characterize the effect of epinephrine on the epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidurally administered opioids.
  
  
  METHODS
  Morphine plus alfentanil, fentanyl, or sufentanil was administered epidurally with and without epinephrine (1:200,000) to pigs. Opioid concentration was subsequently measured in the epidural space, central venous plasma, and epidural venous plasma, and these data were used to calculate relevant pharmacokinetic parameters.
  
  
  RESULTS
  The pharmacokinetic effects of epinephrine varied by opioid and by sampling site. For example, in the lumbar epidural space, epinephrine increased the mean residence time of morphine but decreased that of fentanyl and sufentanil. Epinephrine had no effect on the terminal elimination half-life of morphine in the epidural space, but it decreased that of fentanyl and sufentanil. In contrast, in the lumbar intrathecal space, epinephrine had no effect on the pharmacokinetics of alfentanil, fentanyl, or sufentanil, but it increased the area under the concentration-time curve of morphine and decreased its elimination half-life.
  
  
  CONCLUSIONS
  The findings indicate that the effects of epinephrine on the spinal pharmacokinetics of these opioids are complex and often antithetical across compartments and opioids. In addition, the data clearly indicate that the pharmacokinetic effects of epinephrine in spinal "compartments" cannot be predicted from measurements of drug concentration in plasma, as has been assumed for decades.
authors.affiliation: Department of Anesthesiology, Box 356540, University of Washington, Seattle, Washington 98195, USA. chrisb@u.washington.edu
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bernards
authors.forename: Danny D
authors.initials: DD
authors.lastname: Shen
authors.forename: Emily S
authors.initials: ES
authors.lastname: Sterling
authors.forename: Jason E
authors.initials: JE
authors.lastname: Adkins
authors.forename: Linda
authors.initials: L
authors.lastname: Risler
authors.forename: Brian
authors.initials: B
authors.lastname: Phillips
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ummenhofer
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists; D000316:Adrenergic alpha-Agonists / Q000494:pharmacology*; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000097:blood / Q000134:cerebrospinal fluid / Q000493:pharmacokinetics*; D000779:Anesthetics, Local / Q000494:pharmacology; D000818:Animals; D019540:Area Under Curve; D004824:Epidural Space / Q000378:metabolism; D004837:Epinephrine / Q000494:pharmacology*; D007275:Injections, Intravenous; D007278:Injections, Spinal; D017551:Microdialysis; D020671:Posterior Horn Cells / Q000187:drug effects; D013116:Spinal Cord / Q000378:metabolism; D013552:Swine; D014662:Vasoconstrictor Agents / Q000494:pharmacology*
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D004837:Epinephrine