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REGIONAL ANESTHESIA

The Effect of Large-Dose Intrathecal Opioids on the Autonomic Nervous System

Mashallah Goodarzi, MD^*, and Rajalaxmi R. Narasimhan, MD

*Department of Clinical Anesthesia, University of Southern California, Keck School of Medicine; and Saint Jones Hospital, Los Angeles, California

Address correspondence and reprint requests to Mashallah Goodarzi, MD, Department of Anesthesia Mail # 3, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027.

Decreases in blood pressure after the spinal injection of opioids suggest that intrathecal (IT) opioids may have a sympatholytic effect similar to that of local anesthetic drugs. We compared two groups of patients aged 10–16 yr (n = 10 in each group). Group One (IT group) received IT opioids. Group Two (Epidural group) received 0.5% bupivacaine epidurally. The sympathetic effects of IT opioids and epidural bupivacaine were monitored by the changes in toe relative to calf temperature and by the changes in pulse wave gradients with digital plethysmography. Changes in temperature gradients comparing calf to toe and increases in pulse amplitude indicate vasodilatation caused by sympathetic blockade in this model. Calf to toe temperature gradients (calf-toe) were evaluated by subtracting the two measurements. Pulse wave plethysmography was recorded before and after spinal and epidural injection at intervals of 10 min for 40 min. All patients demonstrated changes in their calf to toe gradients after IT and epidural injections (-3.2 ± 1.6). Systolic blood pressure decreased from a mean of 70 ± 15 mm Hg to 55 ± 10 mm Hg. Pulse wave plethysmography amplitude increased after the intrathecal opioid and epidural bupivacaine injection similarly. We conclude that the increases in pulse wave amplitude and decreases in calf–toe gradients indicate a sympatholytic effect after IT opioids similar to that of local anesthetics.

IMPLICATIONS: The sympatholytic effects of neuraxial opioids were compared with those of local anesthetics. Two groups of patients were assigned to receive a neuraxial opioid or bupivacaine. Our results demonstrate that opioids cause hypotension and peripheral vasodilatation similar to bupivacaine. This finding suggests that neuraxial opioids have a sympatholytic effect comparable to that of local anesthetic drugs.

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