Stable plasma concentrations of unbound ropivacaine during postoperative epidural infusion for 24-72 hours in children

C. B. Berde, M. Yaster, O. Meretoja, M. E. McCann, G. Huledal, U. Gustafsson, L. E. Larsson

Research output: Contribution to journalArticlepeer-review

Abstract

Background and objectives: The aim of this open, non-controlled, multi-centre study was to evaluate the pharmacokinetics and safety of a 24-72 h continuous epidural ropivacaine infusion in children aged 1-9 yr. Methods: After induction of general anaesthesia, 29 ASA I-II children, scheduled for major surgery in dermatomes below T10 had lumbar epidural catheters placed. A bolus of ropivacaine, 2 mg kg-1, was given over 4 min, followed immediately by an infusion of 2 mg mL-1 ropivacaine 0.4 mg kg-1 h -1 for the next 24-72 h. Results: Plasma concentrations of total ropivacaine (mean 0.83 and 1.06 mg L-1 at 16-31 and 59-72 h, respectively) and α1-acid-glucoprotein (mean 13 and 25 μmol L -1 at baseline and 59-72 h) increased over the course of the infusion. Plasma concentrations of unbound ropivacaine were stable throughout the epidural infusion (mean 0.021 range 0.011-0.068 and mean 0.016 range 0.009-0.023 mg L-1 at 16-31 and 59-72 h, respectively) and were well below threshold levels associated with central nervous system toxicity in adults (0.35 mg L-1). Apparent unbound clearance (mean 346, range 86-555 mL min-1 kg-1) showed no age-dependency. No signs of systemic toxicity or cardiovascular effects were observed. All patients received additional analgesics with morphine. Conclusion: Following a 24-72 h epidural infusion of ropivacaine 0.4 mg kg-1 h-1 in 1-9-yr-old children, the plasma concentrations of unbound ropivacaine were stable over time with no age-dependency.

Original languageEnglish (US)
Pages (from-to)410-417
Number of pages8
JournalEuropean Journal of Anaesthesiology
Volume25
Issue number5
DOIs
StatePublished - May 2008

Keywords

  • Anaesthesia conduction, epidural block
  • Anaesthetics local, ropivacaine
  • Analgesia, postoperative
  • Nerve block, continuous epidural infusion
  • Pharmacokinetics, plasma concentrations
  • Postoperative period

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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