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W., Verkman A

Stability of epidural analgesic admixture containing epinephrine, fentanyl, and bupivacaine

Matsuda et al., 1990

Intranasal delivery represents the most significant methodological advancement because it bypasses hepatic first-pass metabolism entirely, but technique sensitivity (nasal cavity anatomy, administration volume, head positioning post-dose) introduces reproducibility challenges that subcutaneous injection avoids

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