Epidural and intrathecal opiates: cerebrospinal fluid and plasma profiles in patients with chronic cancer pain.
Epidural and intrathecal opiates: cerebrospinal fluid and plasma profiles in patients with chronic cancer pain.
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硬膜外和鞘内阿片类药物：慢性癌痛患者的脑脊液和血浆特征。
DOI：
10.1038/clpt.1985.237
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发表时间：
1985
影响因子：
6.7
通讯作者：
Foley,KM
中科院分区：
文献类型：
--
作者：
Max,MB;Inturrisi,CE;Kaiko,RF;Grabinski,PY;Li,CH;Foley,KM
We studied the cerebrospinal fluid (CSF) and plasma concentration‐time profiles of morphine, methadone, and β‐endorphin after lumbar epidural or intrathecal injection in 17 patients with cancer. After epidural injection, all three drugs reached peak levels in lumbar CSF within 34 minutes that were 50 to 1300 times higher than free drug concentrations in plasma. The rate of decline of CSF levels correlated with drug lipid solubility (methadone [t½= 73 minutes] > morphine [126 minutes] > β‐endorphin [317 minutes]). Plasma levels were comparable with those after intragluteal injection of the same dose. In four patients given intrathecal morphine or methadone, CSF at the C1–2level contained high levels of morphine as early as 1 hour after injection, but levels of methadone were lower or undetectable. Three of 17 patients reported improved analgesia initially, but none were improved at 2 weeks after chronic therapy. We conclude that analgesia induced by intrathecal or epidural morphine injections is caused by drug acting at both spinal and supraspinal sites. The use of spinal opiates such as morphine is of limited value in patients whose pain is not adequately managed by high systemic doses of morphine‐like drugs.Clinical Pharmacology and Therapeutics(1985)38, 631–641; doi:10.1038/clpt.1985.237
