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Should a test dose of lidocaine with epinephrine be used with the "walking epidural" technique? [Meeting Abstract]

Roccaforte, JD; Susser, L; Lax, J; Weinberg, J; Fernandez, E; Grant, GJ
ISI:000071851500384
ISSN: 0003-2999
CID: 53562

Wound infiltration with liposomal bupivacaine prolongs analgesia in rats

Grant GJ; Lax J; Susser L; Zakowski M; Weissman TE; Turndorf H
BACKGROUND: Wound infiltration with local anesthetics does not reliably produce satisfactory postoperative analgesia, and the dose of local anesthetic which may be safely administered is limited by the potential for systemic toxicity. This study evaluated the efficacy of a slow-release liposomal bupivacaine formulation on duration of wound analgesia. METHODS: Multilammelar liposomes containing bupivacaine were assessed using a rat paw wound model. Twenty-four hours after surgical incision, paw wounds determined to be hyperalgesic to graded force testing with von Frey hairs were infiltrated with 0.3 ml of 2% liposomal bupivacaine, 0.5% plain bupivacaine, saline, or 'empty' (normal saline) liposomes (n = 6/group). The duration of analgesia was measured. The 0.5% plain concentration was chosen because, in preliminary experiments, larger doses were often fatal. Analgesia duration was compared using Mann-Whitney U test at P 0.05. In other rats, plasma bupivacaine levels after wound infiltration with either 2% liposomal formulation or 0.5% plain formulation were assessed (n = 8/group). RESULTS: The mean duration of analgesia was 23 +/- 3 (SD) min for plain bupivacaine and 180 +/- 30 min for liposomal bupivacaine. No wound analgesia was detected in animals given normal saline or 'empty' liposomes. Plasma bupivacaine levels tended to be lower after liposomal than plain bupivacaine. CONCLUSIONS: The 8-fold increase in duration of wound analgesia and the lower plasma levels seen with the liposomal formulation are explained by gradual drug release from the liposomal depot. These results may have important implications for achieving safe and effective analgesia with wound infiltration techniques in humans
PMID: 9062600
ISSN: 0001-5172
CID: 7159

Hemodynamic effects of intrathecal fentanyl in nonlaboring term parturients

Grant GJ; Susser L; Cascio M; Moses M; Zakowski MI
STUDY OBJECTIVE: To determine the effect of intrathecal fentanyl on maternal hemodynamics. DESIGN: Prospective. SETTING: Labor and delivery suite of a university medical center. PATIENTS: 23 ASA status I nonlaboring term parturients presenting for elective cesarean section. INTERVENTIONS: Patients were given either 1,200 ml lactated Ringer's Solution (Group 1, n = 12) or no intravenous (i.v.) fluid (Group 2, n = 11). A combined spinal-epidural technique was then performed. Fentanyl 25 micrograms was administered intrathecally through a 24-gauge Sprotte or 25-gauge Whitacre spinal needle. After completion of the hemodynamic study, a catheter was threaded into the epidural space for local anesthetic administration. MEASUREMENTS AND MAIN RESULTS: Baseline hemodynamic data [systolic (SBP), diastolic, and mean arterial pressure, heart rate, stroke volume, cardiac output, end-diastolic volume, and ejection fraction] were obtained in triplicate using noninvasive blood pressure monitoring and impedance cardiography. After administration of intrathecal fentanyl, hemodynamic measurements were recorded at 3-minute intervals for 30 minutes. These values were compared with baseline for both groups. Ten patients in each group completed the study. Intrathecal fentanyl administration did not result in any maternal hemodynamic changes in Group 1, and a few small statistically significant changes in Group 2. Measured SBP was always greater than 100 mmHg in all patients during the study. CONCLUSION: Intrathecal administration of fentanyl 25 micrograms in nonlaboring term parturients does not produce clinically important maternal hemodynamic changes
PMID: 8695107
ISSN: 0952-8180
CID: 6913

WOUND INFILTRATION WITH LIPOSOMAL BUPIVACAINE PRODUCES PROLONGED ANALGESIA IN RATS [Meeting Abstract]

GRANT, GJ; LAX, J; SUSSER, L; ZAKOWSKI, M; TURNDORF, H
ISI:A1995RX68500813
ISSN: 0003-3022
CID: 86719

Neuraxial distribution of plain versus liposomal morphine after intrathecal administration in a mouse model [Meeting Abstract]

Grant GJ; Piskoun B; Susser L; Zakowski M; Turndorf H
ORIGINAL:0004951
ISSN: 0146-521x
CID: 47284

Subcutaneous liposomal lidocaine: a pharmacokinetic and pharmacodynamic study in the mouse [Meeting Abstract]

Grant GJ; Piskoun B; Susser L; Zakowski M; Turndorf H
ORIGINAL:0004886
ISSN: 0003-2999
CID: 47219

Modulation of mouse hemoglobin expression by hydroxyurea and erythropoietin in vivo

Alter BP; Wagner CK; Susser LS; Weinberg RS
PMID: 2616578
ISSN: 0361-7742
CID: 35312