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Biomedical subjects

William G Brose

Publications and source records attributed to William G Brose.

3 recordsLinked to original sources

Intrathecal methods.

Although the use of opioids for intrathecal anesthesia was first reported in 1901, it was not until 25 years ago that the first report of selective blockade of pain by spinal opioids was described. Since its beginning, the promise of selective analgesics derived from intraspinal administration has generated much development in the field of pain management. In fact, many anesthesiologists who had previously relegated themselves to the confines of the operating room discovered that their needles and catheters could reach even beyond the inpatient wards, affording patients outside the hospital the opportunity to receive neuraxial drugs. The goal of this article is to report on the current state of spinal analgesic chemotherapy as it is now known.

Analgesia, Epidural↗

CSF and blood pharmacokinetics of hydromorphone and morphine following lumbar epidural administration.

Sixteen consenting patients scheduled for elective thoracotomy were enrolled into a randomized trial of epidural morphine and hydromorphone. Each patient had a lumbar epidural catheter placed preoperatively for the purpose of post-thoracotomy analgesia. Shortly before the end of the operative procedure each patient received 5 mg of morphine and 0.75 mg of hydromorphone via the epidural catheter. Blood was sampled at regular intervals following the opiate administration and patients were randomized to 1 of 7 cervical CSF sampling times. Blood and CSF samples were assayed for morphine and hydromorphone concentration to determine blood and CSF pharmacokinetic profiles. A maximum blood morphine concentration of 60 +/- 25 ng/ml (mean +/- S.D.) was obtained at 11 +/- 6 min (mean +/- S.D.). The blood hydromorphone peak of 14 +/- 13 ng/ml (mean +/- S.D.) occurred 8 +/- 6 min (mean +/- S.D.). The mean peak CSF opioid concentrations of 1581 ng/ml for morphine and 309 ng/ml for hydromorphone occurred 60 min after epidural administration. The blood and CSF pharmacokinetic profiles for morphine and hydromorphone are presented. These profiles are similar for the two drugs after lumbar epidural administration.

Anesthesia, Epidural↗

Subcutaneous lidocaine for treatment of neuropathic cancer pain.

Three patients with terminal malignancy reporting ineffective analgesia using systemic and subsequently spinal opiates were treated with subcutaneous infusion of 10% lidocaine hydrochloride. During the infusion, reasonably stable blood concentrations were achieved and maintained using a subcutaneous infusion at varying dose rates over days to months with improvement of the pain complaints which continued to be refractory to conventional analgesics. Blood lidocaine levels obtained at regular intervals revealed effective concentrations between 2 and 5 micrograms/ml for each patient.

Female↗