Addition of opioids alters the density and spread of intrathecal local anesthetics? An in vitro study

Abstract

Purpose: To determine whether the addition of opioids alters the density and spread of intrathecal local anesthetics in vitro. Methods: In Part I, the densities of hyperbaric bupivacaine 0.75% (HB), hyperbaric lidocaine 5% (HL) and isobaric bupivacaine 0.5% (IB) with and without morphine (M), and fentanyl (F) were measured at 22°C. In Part II a model was constructed utilizing a column containing a solution similar in composition to cerebrospinal fluid (CSF) at 37°C. The various local anesthetic-opioid solutions, coloured with crystalline methylene blue dye, were injected at 22°C into the column at a controlled rate through a spinal needle. The direction and extent of spread of the injectates were compared. Results: The relative densities of the five solutions were: HB = HL > lB > M > E The addition of fentanyl to IB reduced the density of the final solution (P < 0.05). In the model, IB alone and IB with morphine showed mainly downward spread, with the addition of fentanyl to IB resulting in upward movement (P = 0.004). The hyperbaric local anesthetics moved downward with or without opioids. Conclusion: The addition of fentanyl reduces the density of IB in vitro and alters its movement in simulated CSE. This may prove to be important in predicting the level of spinal block in clinical practice.