Tachyphylaxis associated with repeated epidural injections of lidocaine is not related to changes in distribution or the rate of elimination from the epidural space

Journal Article · Tue Aug 01 00:00:00 EDT 1989 · Anesthesia and Analgesia (Cleveland) (Current Researches); (USA)

DOI:https://doi.org/10.1213/00000539-198908000-00007· OSTI ID:5547243

Mogensen, T; Simonsen, L; Scott, N B; Henriksen, J H; Kehlet, H ^[1]

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1. Univ. of Copenhagen (Denmark)

The relationship between tachyphylaxis (measured as a decrease in the rate of regression of sensory levels of analgesia) during repeated epidural injections of lidocaine and both the distribution of lidocaine within the epidural space (as measured by spread of simultaneous injection of the tracer technetium-99m diethylenetriaminepentaacetate (99mTc-DTPA)) and elimination of lidocaine from the epidural space (as measured by serum concentrations of lidocaine) was investigated in 18 patients undergoing minor surgery during lumbar epidural analgesia. Twelve patients received four injections of 20 mL of 2% lidocaine at 2-hr intervals. Epidural distribution was assessed by injection of 99mTc-DTPA diluted in saline on the preoperative day and diluted in an equal volume of 2% lidocaine on the morning before surgery and again after the fourth injection of lidocaine 6 hr later. The distribution of 99mTc-DTPA in the epidural space was unchanged during the three measurements despite significant tachyphylaxis in both sensory analgesia and motor blockade (11 of 12 patients had sensory analgesia 2 hr after the first injection in contrast to only 3 of 12 patients during the third injection). In another six patients 20 mL of 2% lidocaine were injected three times at 2-hr intervals before surgery, with measurements of serum concentrations of lidocaine after the first and last injections. Despite tachyphylaxis (no patient had sensory analgesia 2 hr after the third injection), there was no difference in the rate of disappearance of lidocaine from the epidural space as assessed by plasma lidocaine concentration curves during the first and third injection (0.5 +/- 0.1 and 0.3 +/- 0.04 microgram.mL-1.min-1, respectively).

• OSTI ID: 5547243
• Journal Information: Anesthesia and Analgesia (Cleveland) (Current Researches); (USA), Journal Name: Anesthesia and Analgesia (Cleveland) (Current Researches); (USA) Vol. 69:2; ISSN 0003-2999; ISSN AACRA
• Country of Publication: United States
• Language: English

Related Subjects

550201* -- Biochemistry-- Tracer Techniques
59 BASIC BIOLOGICAL SCIENCES
AMINO ACIDS
ANESTHESIA
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
CARBOXYLIC ACIDS
CHELATING AGENTS
CHROMATOGRAPHY
DISTRIBUTION
DRUGS
DTPA
GAS CHROMATOGRAPHY
HOURS LIVING RADIOISOTOPES
INJECTION
INTAKE
INTERMEDIATE MASS NUCLEI
ISOMERIC NUCLEI
ISOMERIC TRANSITION ISOTOPES
ISOTOPE APPLICATIONS
ISOTOPES
MEDICINE
NERVES
NERVOUS SYSTEM
NUCLEI
ODD-EVEN NUCLEI
ORGANIC ACIDS
ORGANIC COMPOUNDS
PATIENTS
RADIOISOTOPES
RADIOPROTECTIVE SUBSTANCES
SEPARATION PROCESSES
SURGERY
TECHNETIUM 99
TECHNETIUM ISOTOPES
TISSUE DISTRIBUTION
TRACER TECHNIQUES
YEARS LIVING RADIOISOTOPES