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Subarachnoid Bupivacaine Increases Human Cerebrospinal Fluid Concentration of Serotonin
  1. O. Naesh, M.D., Ph.D.,
  2. I. Hindberg, Ph.D. and
  3. C. Christiansen, M.D.
  1. Departments of Anesthesia and Clinical Chemistry Frederiksberg Hospital, Frederiksberg, Denmark
  1. Reprint requests: O. Naesh, M.D., Ph.D., Department of Anesthesia, Jerudong Park Medical Centre, 2021 Brunei Darussalam.


Background and Objectives Serotonin (5-hydroxytryptamine [5-HT]) has antinociceptive properties at the spinal level. Activation of descending serotonergic neurons or topically applied 5-HT at the spinal cord inhibits rostral spread of sensory information. Epidural anesthesia has been shown to increase 5-HT in plasma, and local anesthetics may interfere with 5-HT reuptake and metabolism. For these reasons, the action of subarachnoid local anesthetics on cerebrospinal fluid (CSF) 5-HT concentrations has been studied.

Methods Six volunteers received lumbar spinal anesthesia with 0.5% bupivacaine through subarachnoid catheters, and CSF and plasma 5-HT concentrations were determined radioenzymatically before and after anesthesia.

Results Plasma 5-HT was unchanged, but CSF 5-HT increased by 300% after bupivacaine administration (P < .02).

Conclusion Subarachnoid bupivacaine increases local 5-HT concentration. This may have implications for nociceptive gating as well as for local vasoregulation.

  • regional anesthesia
  • cerebrospinal fluid
  • serotonin
  • nociception

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  • Supported in part by ASTRA-Denmark and the Lunsbeck Foundation.