==================================HSR19================================== 19. This search is to be conducted on epidural catheters: - administering medication using epidural catheters - nursing and infection control implications - nursing care of - complications and infection of epidural catheters. 1 UI - 87123300 AU - Beck H ; Brassow F ; Doehn M ; Bause H ; Dziadzka A ; Schulte am Esch J TI - Epidural catheters of the multi-orifice type: dangers and complications. AB - A study on epidural catheters of the multi-orifice type, investigating their tendency to epidurovasal (with an intravascularly positioned catheter tip) and epidurosubarachnoid (with the catheter tip inserted in the subarachnoid space) malpositioning, was conducted on 113 patients using clinical and radiological criteria as controls. Of the improperly placed catheters, 13 were in an epidurovasal (11.5%) and one was in an epidurosubarachnoid (0.9%) position. The findings demonstrate the occasional hazardous dual compartmental misplacement of multi-orifice catheters, in which a distal opening can lie intravascularly or within the subarachnoid space, while a proximal orifice simultaneously retains normal access to the epidural space. The insufficiency of controlling or even recognizing such improperly placed catheters which are only partially in the epidural space, as well as the danger of causing a secondary dural or vascular perforation with epidural catheters, is discussed. Since epidural catheters of the multi-orifice type apparently represent an inherent, vital danger due to their construction (regardless of the catheter material and workmanship), they should no longer be used. MH - Aged ; Aged, 80 and over ; Anesthesia, Epidural/*INSTRUMENTATION/METHODS ; Anesthetics, Local/*ADVERSE EFFECTS ; Blood Vessels/INJURIES ; Catheterization/*INSTRUMENTATION ; Central Nervous System Diseases/ *CHEMICALLY INDUCED ; Dura Mater/INJURIES ; Heart Diseases/*CHEMICALLY INDUCED ; Human ; Intraoperative Complications/ETIOLOGY ; Middle Age ; Subarachnoid Space SO - Acta Anaesthesiol Scand 1986 Oct;30(7):549-55 2 UI - 87074145 AU - Hardy PA TI - Can epidural catheters penetrate dura mater? An anatomical study. AB - A study using postmortem dura mater and arachnoid mater showed that catheter perforation of dura did not occur. In contrast, perforation of arachnoid proved easy. MH - Adult ; Anesthesia, Epidural/*INSTRUMENTATION ; Arachnoid/ANATOMY & HISTOLOGY/INJURIES ; Catheterization/*ADVERSE EFFECTS ; Dura Mater/ ANATOMY & HISTOLOGY/*INJURIES ; Human ; In Vitro SO - Anaesthesia 1986 Nov;41(11):1146-7 3 UI - 87035188 AU - Baggerly J TI - Epidural catheters for pain management: the nurse's role. AB - Epidural catheters for the injection of low-dose morphine are being used in selected individuals to manage pain. This article describes the rationale for this treatment modality and discusses the role of the nurse in evaluation, postoperative care, and discharge planning. MH - Catheters, Indwelling/ADVERSE EFFECTS/*NURSING ; Chronic Disease ; Human ; Injections, Epidural/*INSTRUMENTATION/METHODS ; Morphine/ *ADMINISTRATION & DOSAGE ; Pain/*DRUG THERAPY/NURSING ; Pain, Intractable/ *DRUG THERAPY/NURSING ; Patient Discharge ; Patient Education SO - J Neurosci Nurs 1986 Oct;18(5):290-5 4 UI - 86311699 AU - Takizawa H ; Gabra-Sanders T ; Miller JD TI - Analysis of changes in intracranial pressure and pressure-volume index at different locations in the craniospinal axis during supratentorial epidural balloon inflation. AB - During experimental supratentorial epidural compression of the brain, cerebrospinal fluid (CSF) pressure and pressure-volume index (PVI) were measured in the supra- and infratentorial compartments of the craniospinal axis in anesthetized ventilated cats. A transtentorial gradient of CSF pressure developed when CSF pressure in the lateral ventricle exceeded 20 mm Hg at balloon volumes of 0.4 to 1.2 ml. The shapes of both the pressure vs. volume and the pressure gradient vs. volume curves were exponential. PVI in the supratentorial compartment was lowered more rapidly as brain compression advanced than PVI in the infratentorial compartment. An index was calculated to represent the relative resistance to the flow of CSF across the tentorial hiatus during supratentorial brain compression. This revealed different resistances to the flow of CSF in the cephalic and caudal directions. A hypothesis concerning the hydrodynamic aspects of the development of tentorial herniation is presented. MH - Animal ; Body Fluid Compartments ; Catheterization ; Cats ; Cerebral Ventricles/PHYSIOPATHOLOGY ; Cerebrospinal Fluid/METABOLISM/*PHYSIOLOGY ; Cisterna Magna ; Encephalocele/*PHYSIOPATHOLOGY ; Epidural Space ; Female ; *Intracranial Pressure ; Male ; Sodium Chloride/ADMINISTRATION & DOSAGE ; Stereotaxic Technics ; Support, Non-U.S. Gov't SO - Neurosurgery 1986 Jul;19(1):1-8 5 UI - 86266842 AU - Caballero GA ; Ausman RK ; Himes J TI - Epidural morphine by continuous infusion with an external pump for pain management in oncology patients. AB - Ten patients with advanced malignancies and severe pain were given epidural morphine (EDM) by continuous infusion. The pain had been treated previously with large doses of oral or parenteral narcotics, without success. The pain was disabling in all the cases. The total dose of morphine administered was 10-90 mg per day; median dose was 25 mg. Treatment lasted from 9 to 400 days. Pain relief was complete in seven patients, near complete in two, and moderate in one. Five patients became fully ambulatory. Two patients were treated as outpatients and resumed work activities. No central nervous system or gastrointestinal adverse effects, respiratory depression, or pruritus were noted. One patient developed urinary retention. EDM by continuous infusion produced constant pain relief for prolonged periods. This technique is safe for analgesia in oncology patients and suited for outpatient management. MH - Aged ; Epidural Space ; Female ; Human ; Infusions, Parenteral/ INSTRUMENTATION ; Male ; Middle Age ; Morphine/*ADMINISTRATION & DOSAGE ; Neoplasms/*COMPLICATIONS ; Pain, Intractable/*DRUG THERAPY/ PHYSIOPATHOLOGY SO - Am Surg 1986 Jul;52(7):402-5 6 UI - 86236808 AU - Gordh T ; Wiklund L TI - A method for reliable and simultaneous cannulation of the epidural and subarachnoid spaces in pigs. A tool for the study of cerebrospinal fluid pharmacokinetics and drug penetration of the dura mater. AB - Many drugs are of interest from the point of view of their pharmacokinetical properties in the CSF, as well as their penetration of the dura mater after epidural application. A means of assessment of these properties is therefore of importance. The present report describes a method allowing reliable simultaneous cannulation of the epidural and subarachnoid spaces in the anaesthetized pig, with control of the catheter positions. The catheter tips can be placed at the same spinal level, separated only by the dura mater and arachnoid membrane. Both catheters are introduced via the atlanto-occipital membrane. We found this method a valuable tool in the research of drug disposition and other experimental procedures, where simultaneous and reliable access to the subarachnoid and epidural spaces is mandatory. MH - Animal ; Catheterization/*METHODS ; Drugs/*METABOLISM ; Dura Mater/ *METABOLISM ; *Epidural Space ; Kinetics ; *Spinal Canal ; *Subarachnoid Space ; Swine SO - Ups J Med Sci 1986;91(1):111-5 7 UI - 86213192 AU - Durant PA ; Yaksh TL TI - Distribution in cerebrospinal fluid, blood, and lymph of epidurally injected morphine and inulin in dogs. AB - We describe procedures for catheterizing the epidural space, the azygos vein, and the thoracic lymph duct of dogs without using fluoroscopy. The success rates of the procedures were 100, 80, and 50%, respectively (n = 10). To assess the validity of the model, 3H-morphine and unlabeled morphine (2 mg) were injected epidurally in ten dogs. Lumbar cerebrospinal fluid (CSF), azygos venous blood, arterial blood, and lymph were sampled before and 5, 20, 60, 120, 180, 240, 300 and 360 min after injection. During the first 20 min, morphine levels in the azygos vein were about three and ten times greater than arterial and lymphatic levels, respectively (n = 3; P less than 0.01). Morphine levels were significantly greater in the azygos vein (n = 8) and the femoral artery (n = 10) during the first 20 and 60 min than they were later, respectively (P less than 0.05). In the lymph (n = 5), the levels of morphine at 60 min were statistically greater (P less than 0.05) than levels at 4, 5, and 6 hr. At no time were the concurrent arterial and lymph levels different from each other. In the lumbar CSF, the morphine peak concentration was reached 5-60 min after epidural injection and ranged between 5 and 93 micrograms/ml. In the CSF, the levels of morphine were significantly greater during the first 20 min than later (n = 7; P less than 0.05). The washout of the lumbar CSF curve for morphine appeared to be fitted by a two-compartment open model. The t1/2-alpha and t1/2-beta values were 14.7 +/- 7.2 min and 106 +/- 45 min, respectively (mean +/- SD). Cumulative percentages of the epidural dose of morphine passed into the azygos system within the first 5, 20, 60, and 120 min after injection were calculated to be 4.0 +/- 2.1, 23.5 +/- 14.6, 49.2 +/- 34.2, and 55.9 +/- 35.3, respectively (mean +/- SD; n = 8). Both 14C-inulin and 3H-morphine were injected epidurally in one dog and intrathecally in another dog. In the CSF, morphine appears to be cleared at a rate similar to that of inulin. The fraction of morphine and inulin crossing the dura after epidural injection was calculated to be 0.31% and 0.59%, respectively. MH - Animal ; Azygos Vein ; Carbon Radioisotopes/DIAGNOSTIC USE ; Catheterization ; Dogs ; Epidural Space ; Female ; Femoral Artery ; Half-Life ; Inulin/BLOOD/CEREBROSPINAL FLUID/*METABOLISM ; Kinetics ; Male ; Metabolic Clearance Rate ; Morphine/BLOOD/CEREBROSPINAL FLUID/ *METABOLISM ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Tissue Distribution ; Tritium/DIAGNOSTIC USE SO - Anesth Analg 1986 Jun;65(6):583-92 8 UI - 86211063 AU - Treffers R ; de Lange JJ TI - A patchy loco-regional hypalgesia due to subdural catheter placement. AB - We discuss a unique case of perforation of the dura mater, but not of the arachnoidea, by an epidural catheter. The injected test dose of the local anesthetic agent caused a partial subdural and a partial epidural hypalgesia. The exact position of the catheter and the distribution of the local anesthetic agent was confirmed by radiographic contrast material. MH - Aged ; Anesthesia, Epidural/*ADVERSE EFFECTS ; Case Report ; Catheterization/*ADVERSE EFFECTS ; Epinephrine/PHARMACODYNAMICS ; Human ; Hypesthesia/*ETIOLOGY ; Male ; Sensory Thresholds ; Subdural Space SO - Acta Anaesthesiol Belg 1986;37(1):59-61 9 UI - 86195042 AU - Cooper GL ; Roberts JT ; O'Brien A ; Kelleher M ; Dretler SP ; Battit GE ; Hopkins CC TI - Microbial examination of kidney lithotripter tub water and epidural anesthesia catheters. AB - Kidney lithotripsy patients frequently receive epidural anesthesia via indwelling epidural catheters. In our hospital, patients are immersed in a tub of warm, continuously-flowing tap water. The epidural catheter-entry site is covered by a transparent occlusive dressing. To determine the risk of microbial colonization of the epidural catheter during lithotripsy, we performed quantitative cultures of tub water and semiquantitative cultures of catheters in 63 lithotripsy procedures. Most of the tub water organisms were typical tap water and skin flora isolates. Total colony counts were generally low with no significant progression during the course of serial procedures. Forty-two epidural catheters were cultured; 34 (81%) were sterile, 8 (19%) were colonized with small numbers of flavobacteria or coagulase-negative staphylococci. Only four catheters had organisms present on catheter segments covered by the transparent occlusive dressing (in each case there was a single colony forming unit per semiquantitative plate) and these organisms were probable contaminants. We conclude that with our current lithotripsy procedures, the risk for the development of epidural catheter-associated infection seems to be low. MH - Anesthesia, Epidural/*INSTRUMENTATION ; Catheters, Indwelling ; *Equipment Contamination ; Human ; *Lithotripsy ; Risk ; Staphylococcus/ *ISOLATION & PURIFICATION ; Support, U.S. Gov't, P.H.S. ; *Water Microbiology SO - Infect Control 1986 Apr;7(4):216-9 10 UI - 86184481 AU - Hardy PA TI - Force exerted by epidural catheters. AB - In a study of epidural catheters, it was found that catheter material and catheter diameter both influenced in force exerted. Catheters made of nylon exert less force than those made of polyethylene. Diameter is proportional to the logarithm of force exerted. MH - Catheterization/*INSTRUMENTATION/METHODS ; Epidural Space ; Equipment Design ; Nylons ; Polyethylenes SO - Anaesthesia 1986 Mar;41(3):306-8 11 UI - 86180372 AU - Staren ED ; Cullen ML TI - Epidural catheter analgesia for the management of postoperative pain. AB - Since its introduction to North America in 1942, the use of epidural catheter analgesia has increased dramatically. Improved equipment, methods and medications have broadened its application to include among others, surgical anesthesia, chronic pain relief and the management of postoperative pain. Numerous techniques for epidural puncture and insertion of the catheter have been described. Although complications have been associated with placement of an epidural catheter, these are rare when performed by an experienced anesthesiologist. Epidural analgesia was first accomplished by blockade with local anesthetics. Bupivacaine has been called the local anesthetic of choice for epidural infusion. Bolus administration of epidural local anesthetics gives effective analgesia; however, its use is limited by brief duration and occasionally severe hypotension. Epidural local anesthetics have been administered by continuous infusion in an attempt to minimize side effects. Nevertheless, hypotension, as well as motor block, numbness, nausea and urinary retention have occurred. Epidural analgesia with local anesthetics is effective in relieving postoperative pain, but its safety and feasibility have been questioned because of the frequent, potentially serious side effects. These problems led to trials of epidural narcotics for postoperative pain management. The exact site of action of epidural narcotic analgesics is debatable; however, the bulk of evidence supports a direct spinal action. Epidural narcotics appear to specifically inhibit nociceptive stimuli. The prolonged and profound analgesia that occurs with epidural narcotics relative to parenteral administration is due to a higher concentration of drug reaching the CSF through the epidural route. Since nervous transmission is not completely blocked this technique cannot provide anesthesia during operation. Morphine has been the most frequently used narcotic for epidural analgesia. Results of several recent, randomized double-blind studies have shown that epidural narcotics give adequate analgesia comparable with that observed with epidural bupivacaine. Epidural morphine provides a greater duration of analgesia and may cause fewer side effects. Improved analgesia has been reported when epidural narcotics are used in combination with local anesthetics. Continuous administration of low dosage epidural narcotics has been shown to have less frequent side effects than bolus administration. Nevertheless, pruritus, urinary retention, hypotension and severe respiratory depression have been reported with both methods.(ABSTRACT TRUNCATED AT 400 WORDS) MH - Analgesia/*METHODS ; Anesthesia, Epidural/ADVERSE EFFECTS/METHODS ; Anesthesia, Local/METHODS ; Blood Pressure/DRUG EFFECTS ; Bupivacaine/ ADMINISTRATION & DOSAGE/ADVERSE EFFECTS ; Catheters, Indwelling ; Comparative Study ; Drug Therapy, Combination ; Epidural Space/ANATOMY & HISTOLOGY ; Human ; Hypotension/CHEMICALLY INDUCED ; Morphine/ ADMINISTRATION & DOSAGE ; Pain, Postoperative/*DRUG THERAPY ; Respiratory Function Tests ; Review ; Urinary Catheterization SO - Surg Gynecol Obstet 1986 Apr;162(4):389-404 12 UI - 86172018 AU - Ekelund L ; Lindstedt E ; Lundquist SB ; Sundin T ; White T TI - Studies on renal damage from percutaneous nephrolitholapaxy. AB - To study in detail the effects of percutaneous nephrolitholapaxy on renal function, a consecutive series of 11 patients were investigated preoperatively by excretory urography, gamma camera renography for determination of individual renal function and computerized tomography of the kidneys. Postoperatively, gamma camera examination, computerized tomography, antegrade nephrostography, renal angiography and excretory urography were performed. With 2 exceptions, percutaneous nephrostomy, dilation of the tract and stone removal were done in 1 stage with the patient under continuous epidural anesthesia. Nephrostomy tract dilation was done with an Olbert type balloon catheter or Alken metallic dilators. Thickening of Gerota's fascia was demonstrated by computerized tomography in most cases, and small to moderate perirenal hematomas were found in several. At gamma camera examination decrease of renal function was noted regularly on postoperative day 1 and returned to near initial levels 2 weeks postoperatively in most cases. Angiography in 10 patients showed discrete parenchymal scarring in some and a peripheral arteriovenous fistula in 1. We conclude that percutaneous renal stone surgery usually is tolerated well by the kidney. MH - Adult ; Aged ; Angiography ; Catheterization/ADVERSE EFFECTS ; Dilatation/ ADVERSE EFFECTS ; Female ; Human ; Kidney/*INJURIES/RADIOGRAPHY/ RADIONUCLIDE IMAGING ; Kidney Calculi/*SURGERY ; Kidney Function Tests ; Male ; Middle Age ; Nephrostomy, Percutaneous/ADVERSE EFFECTS ; Postoperative Complications/*ETIOLOGY/RADIOGRAPHY ; Prospective Studies ; Tomography, X-Ray Computed SO - J Urol 1986 Apr;135(4):682-5 13 UI - 86157157 AU - Dagi TF ; Chilton J ; Caputy A ; Won D TI - Long-term, intermittent percutaneous administration of epidural and intrathecal morphine for pain of malignant origin. AB - Eight patients with intractable pain of malignant origin were treated by the surgical implantation of externalized catheters for percutaneous injection of morphine into the spinal epidural or the cerebral intraventricular space. Follow-up ranged from 48 hr to 1 yr. Four catheters (50%) malfunctioned mechanically and were repaired. Two were imputed in systemic infection and were removed. One patient developed paradoxical responses and discontinued catheter use. Every patient enjoyed excellent relief for a significant time with full preservation of mental capacities. The attractive simplicity of this morphine delivery system deserves further study. MH - Adult ; Catheterization/*METHODS ; Cerebral Ventricles ; Epidural Space ; Female ; Human ; Male ; Middle Age ; Morphine/*ADMINISTRATION & DOSAGE ; Neoplasms/*PHYSIOPATHOLOGY ; Pain, Intractable/*DRUG THERAPY ; Time Factors SO - Am Surg 1986 Mar;52(3):155-8 14 UI - 86154949 AU - Larsen JJ ; Svendsen O ; Andersen HB TI - Microscopic epidural lesions in goats given repeated epidural injections of morphine: use of a modified autopsy procedure. AB - Epidural catheterization was performed in six goats. Five days later either saline or 20 mg (5 mg/ml) preservative free morphine was injected epidurally once daily for 8 days. The goats were sacrificed 4, 24 or 48 hours after the last injection. The lumbar part of columna was removed in toto for microscopic examination of the spinal cord and the entire epidural space after decalcification and transverse sectioning. After saline, minimal changes including a fibrous membrane surrounding the catheter, scattered fat cell necrosis, scattered small focal cell infiltrations and occasionally focal haemorrhages were seen. After morphine the changes were considerably more severe including diffuse cellular inflammatory reaction in the epidural space, fat cell necrosis, occasionally focal exudative inflammation and chronic inflammatory reaction in the vicinity of the fibrous membrane demarcating position of the catheter. It is concluded that the present modified autopsy procedure permits microscopic examination of the epidural space. It has been shown that repeated administration of morphine caused tissue damage in the epidural space of goats. The human predictability of the results obtained is unknown. However, the results are encouraging for investigations with similar procedure in humans. MH - Animal ; Autopsy ; Catheterization/ADVERSE EFFECTS ; Epidural Space/*DRUG EFFECTS/PATHOLOGY ; Female ; Goats ; Irritants/TOXICITY ; Lidocaine/ ADVERSE EFFECTS ; Male ; Morphine/ADMINISTRATION & DOSAGE/*TOXICITY ; Spinal Canal/*DRUG EFFECTS ; Spinal Cord/DRUG EFFECTS SO - Acta Pharmacol Toxicol (Copenh) 1986 Jan;58(1):5-10 15 UI - 86104011 AU - Kerr-Wilson RH ; McNally S TI - Bladder drainage for caesarean section under epidural analgesia. AB - Fifty patients undergoing elective caesarean section under epidural analgesia were randomized prospectively to be catheterized with an 'in-out' or an indwelling urethral catheter. Of the patients who had catheterization for the time of surgery alone 44% subsequently required recatheterization, whereas all patients with indwelling catheters voided spontaneously on their removal. The frequency of significant bacteriuria was the same in both groups. MH - Adult ; *Anesthesia, Epidural ; Bladder/PHYSIOPATHOLOGY ; Catheters, Indwelling ; *Cesarean Section ; Drainage ; Female ; Human ; Postoperative Period ; Pregnancy ; *Urinary Catheterization ; Urination Disorders/ETIOLOGY/*PREVENTION & CONTROL SO - Br J Obstet Gynaecol 1986 Jan;93(1):28-30 16 UI - 86101323 AU - Durant PA ; Yaksh TL TI - Epidural injections of bupivacaine, morphine, fentanyl, lofentanil, and DADL in chronically implanted rats: a pharmacologic and pathologic study. AB - A new technique of epidural catheterization in rats is described. The pharmacologic characterizations of the model were established after epidural injection of bupivacaine, morphine, fentanyl, lofentanil, and D-Ala2-D-Leu5-enkephalin (DADL) on hot plate (HP) and tail flick (TF). In addition, rostral spread, motor function, behavior, and reproducibility of the effects over time were assessed. The time-response curves showed an almost immediate onset of action for bupivacaine, fentanyl, and lofentanil and a delayed onset for morphine and DADL. Morphine and lofentanil displayed a significantly longer duration of action than bupivacaine, fentanyl, and DADL. The dose-response curves were monotonic and the slopes were log-linear. Based on the ED50 values, the following rank order of potency was obtained 1 day after catheterization for both HP and TF: lofentanil much greater than fentanyl greater than morphine much greater than DADL greater than bupivacaine. Intraperitoneal (IP) administration of naloxone antagonizes the agonist effects of epidural morphine, fentanyl, and lofentanil. To assess the role in analgesia played by epidural vascular uptake after epidural administration of morphine, fentanyl, and lofentanil, the lowest maximally effective epidural dose of these agents was given intravenously. After iv fentanyl and lofentanil, the analgesic and behavioral effects were not different from the values obtained after epidural administration. By contrast, the effects were negligible after iv morphine when compared with the epidural route. Epidural vascular uptake is thought to be low for morphine and high for fentanyl and lofentanil. The reproducibility of the analgesic and behavioral effects over time was assessed by epidurally injecting the lowest maximally effective dose of bupivacaine, morphine, fentanyl, and lofentanil 1 day and 10 days after catheterization. After 10 days, a significant reduction of analgesic and behavioral effects was noted and was thought to be due to a complete fibrotic sheath surrounding the epidural catheter. MH - Analgesia ; Analgesics, Addictive/ADMINISTRATION & DOSAGE/ *PHARMACODYNAMICS ; Animal ; Behavior, Animal/DRUG EFFECTS ; Bupivacaine/ ADMINISTRATION & DOSAGE/*PHARMACODYNAMICS ; Catheterization/ADVERSE EFFECTS ; Catheters, Indwelling ; Enkephalin, Leucine/*ANALOGS & DERIVATIVES/ADMINISTRATION & DOSAGE/PHARMACODYNAMICS ; Epidural Space/ PATHOLOGY ; Fentanyl/*ANALOGS & DERIVATIVES/ADMINISTRATION & DOSAGE/ *PHARMACODYNAMICS ; Male ; Morphine/ADMINISTRATION & DOSAGE/ *PHARMACODYNAMICS ; Motor Activity/DRUG EFFECTS ; Naloxone/ PHARMACODYNAMICS ; Rats ; Rats, Inbred Strains ; Reaction Time/DRUG EFFECTS ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Time Factors SO - Anesthesiology 1986 Jan;64(1):43-53 17 UI - 86101277 AU - Thompson GA ; Turner PA ; Bridenbaugh PO ; Stuebing RC ; Denson DD TI - The influence of diazepam on the pharmacokinetics of intravenous and epidural bupivacaine in the rhesus monkey. AB - Pretreatment of patients with diazepam has been reported to reduce the plasma half-life of epidurally administered bupivacaine. The concentrations of bupivacaine used to estimate its plasma half-life may be influenced by input into the vascular system (rate and extent of absorption from the epidural space) and disposition (distribution and elimination). We conducted a study in Rhesus monkeys in which the input function was known and the influence of intravenous diazepam on the disposition of intravenous bupivacaine could be delineated. Results indicated no differences in the primary pharmacokinetic parameters (i.e., total clearance and volume of distribution) for the disposition of bupivacaine. To determine whether the apparent disparity between these results and a previous study might be due to a diazepam-induced alteration in the input function, the influence of intravenous diazepam or saline on the mean absorption time of epidurally administered bupivacaine was also studied in monkeys. Epidural bupivacaine was completely absorbed whether the animals received intravenous saline or intravenous diazepam. No significant differences in pharmacokinetic parameters were found between animals pretreated with intravenous saline or intravenous diazepam and receiving an epidural injection of bupivacaine. The mean residence time of bupivacaine in the body (P less than 0.01) and plasma elimination half-life (P less than 0.005) were significantly longer after epidural administration than after intravenous administration. Intravenous diazepam does not alter the pharmacokinetics of intravenously or epidurally administered bupivacaine. MH - Absorption ; Animal ; Bupivacaine/ADMINISTRATION & DOSAGE/*METABOLISM ; Diazepam/*PHARMACODYNAMICS ; Drug Interactions ; Epidural Space ; Half-Life ; Infusions, Parenteral ; Kinetics ; Macaca mulatta ; Support, Non-U.S. Gov't SO - Anesth Analg 1986 Feb;65(2):151-5