The Cerebrospinal Fluid and Plasma Pharmacokinetics of Sufentanil After Thoracic or Lumbar Epidural Administration

Comment This is one of many articles in the literature addressing the neuroaxial administration of lipophilic opiates. The finding of higher concentrations of sufentanil in cerebrospinal fluid (CSF) compared with plasma supports the concept of a spinal site of action when opiates are administered epidurally. Moreover, sufentanil was found to be localized in CSF to the level of administration, suggesting that the anesthesiologist should tailor the epidural site of administration to the level of nociceptive input. Additionally, the finding that sufentanil was eliminated more rapidly from CSF than from plasma implies a higher risk of accumulation of sufentanil in plasma after repeated epidural administrations.