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REGIONAL ANESTHESIA

Hypercarbic and Hypoxic Ventilatory Responses After Intrathecal Administration of Bupivacaine and Sameridine

Department of Anesthesiology and Intensive Care, Karolinska Hospital and Institute, Stockholm, Sweden

Address correspondence and reprint requests to Åsa Österlund Modalen, MD, Karolinska Hospital and Institute, S-171 76 Stockholm, Sweden. Address e-mail to asamodalen{at}hotmail.com

Sameridine is a new compound with both local anesthetic and opioid properties (partial µ-opioid receptor agonist). It was intended for intrathecal administration to provide anesthesia for surgery and extended postoperative analgesia. In this double-blinded pharmacodynamic study with a two-parallel-group design, we investigated, during a 24-h period, the effects of intrathecal sameridine and bupivacaine on ventilation at rest and at ventilatory challenges during hypercarbia and hypoxia. Twenty-four healthy volunteers received either 25 mg of sameridine or 15 mg of bupivacaine intrathecally. Ventilation was measured by pneumotachography and in-line capnography. Sedation was rated by a visual analog scale. Segmental spread and development of motor and sensory block were similar in both groups. There was a decrease in tidal volume 2.5 to 6 h after injection in the bupivacaine group. This was seen only at 4 h in the sameridine group. There were no other major ventilatory differences between sameridine and bupivacaine during resting ventilation. Hypercarbic (tidal volume, mean inspiratory flow) and hypoxic (mean inspiratory flow) ventilatory responses were slightly decreased in the sameridine group, but not in the bupivacaine group. We conclude that intrathecal administration of sameridine or bupivacaine in healthy volunteers produces similar, minor effects on ventilatory responses over a 24-h observation period.

IMPLICATIONS: Intrathecal administration of sameridine, a new molecule with both local anesthetic and opioid properties, compared with bupivacaine, a well-known local anesthetic, produces similar and minor effects on respiration over a 24-h observation period.

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