CSF morphine levels after lumbar intrathecal administration of isobaric and hyperbaric solutions for cancer pain

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SummaryThe objectives of this study were to compare the pharmacokinetic properties and the duration of analgesia following intrathecal administration (L5–S1) of 2 mg morphine in 2 forms: (1) an isobaric (NaCl 0.9%) and (2) a hyperbaric solution (7% dextrose). The study was carried out on 5 cancer patients with severe, intractable pain in the lower half of the body.Samples of CSF were collected at the level of the 10th thoracic vertebra at regular intervals for 15 h after administration. Morphine concentrations were determined by HPLC.The pharmacokinetic properties of the solutions (I and II) were quite different.Peak levels (I) were reached in 5–15 min (30 and 60 μg/ml); they then fell rapidly durin the 1st hour (7 and 11 μg/ml) with an elimination half-life of 10 and 15 min, followed by a change in slope (elimination half-life of 108 and 140 min).Peak levels (II) were reached in 4–5 h (0.8–3.3 μg/ml); they then fell progressively according to a single exponential function (elimination half-life: 144–246 min).The duration of analgesia for a dose of 2 mg was 30 h for solution 2 and 24 h for solution 1.The hyperbaric solution, which produced the same degree of analgesia as the isobaric solution, limited the cephalad diffusion of morphine and reduced or abolished the central depressant effects of the drug.

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