Bupivacaine Metabolite Can Interfere with Norfentanyl Measurement by LC-MS/MS.

Autor:	Mahowald G; Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Khaliq T; Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Basu S; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA., Griggs D; Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Siegel M; Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Leffert L; Department of Anesthesiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.; Department of Anesthesiology, Yale-New Haven Hospital and Yale Medical School, New Haven, CT., Bernstein S; Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Flood JG; Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Uljon S; Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Jazyk:	angličtina
Zdroj:	The journal of applied laboratory medicine [J Appl Lab Med] 2022 Jun 30; Vol. 7 (4), pp. 854-862.
DOI:	10.1093/jalm/jfac009
Abstrakt:	Background: Liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) is the gold standard for the measurement of fentanyl and norfentanyl (NF) in urine and is favored over immunoassays due to its superior specificity. NF is the principal metabolite of fentanyl found in the urine and is typically present in higher abundance than fentanyl. Thus, the sensitivity and specificity of LC-MS/MS relies largely on the ability to identify and quantitate NF. Methods: We analyzed urine specimens from women who had received bupivacaine and fentanyl for epidural analgesia during labor. We analyzed the contents of the epidural bag itself and purified bupivacaine metabolite N-desbutyl bupivacaine [or N-(2,6-dimethylphenyl)piperidine-2-carboxamide (NDB)] by LC-MS/MS. Results: NDB interferes with the LC-MS/MS assay for NF. NDB passes through the Q1 mass selection filter because it is isobaric with the NF precursor ion (233 m/z). Further, it shares product ions with NF (84 m/z and 150 m/z), used as quantifier and qualifier ions, respectively, in our urine NF detection method. Baseline resolution of NDB and NF using these quantifier and qualifier ions could not be achieved. A unique product ion of NF (177 m/z) was useful for distinguishing NDB from NF. Conclusion: Bupivacaine is a commonly used drug. Recognition of this interference by laboratories is critical for preventing the misidentification of NF, which can have profound effects on patient care. (© American Association for Clinical Chemistry 2022. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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