Hemodynamic and electroencephalographic effects of epidural buprenorphine during orthopedic hindlimb surgery in sheep: A comparison with intramuscular buprenorphine and epidural saline

Epidural opioids exert segmentally limited spinal analgesia by acting at dorsal horn neurons. While the spinal cord may be the predominant site of action for hydrophilic opioids such as morphine, initial supraspinal effects have been suggested for lipophilic opioids such as buprenorphine. In view of significant systemic effects, the value of epidural administration of lipophilic opioids in human patients has been questioned. Since epidural buprenorphine may be beneficial for hindlimb surgeries in sheep, intraoperative hemodynamic and central nervous effects were evaluated. In a prospective, randomized, and placebo-controlled study, 15 adult sheep anesthetized for cranial cruciate ligament reconstruction were treated with either epidural buprenorphine (5 μg/kg, n = 5), intramuscular buprenorphine (5 μg/kg, n = 5), or epidural saline (0.15 ml/kg, n = 5) preoperatively. Heart rate, arterial blood pressures and the electroencephalographic variables ϑ/δ ratio, α/δ ratio, β/δ ratio, median power frequency (MED), and 80% spectral edge frequency were recorded before and immediately after skin incision and during drilling a tunnel through the tibia bone. Arterial pressures after epidural buprenorphine were significantly lower compared with epidural saline but were quite similar to intramuscular buprenorphine before skin incision. Mean EEG ϑ/δ ratios and MED values following epidural and intramuscular buprenorphine were significantly lower compared with epidural saline but quite similar for the two buprenorphine groups during drilling. In conclusion, similar hemodynamic and electroencephalographic effects of epidural and intramuscular buprenorphine suggest systemic effects of epidural buprenorphine in sheep.