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Bupivacaine pharmacokinetics during epidural anaesthesia in children
I Murat1, G Montay, M M Delleur
1Départment d'Anesthésie-Réanimation Chirurgicale, Hôpital Saint-Vincent-de-Paul, Paris, France.
Insights
Bupivacaine
Area of Science:
- Pharmacology
- Pediatric Anesthesiology
Background:
- Bupivacaine is a commonly used local anesthetic in pediatric epidural anesthesia.
- Understanding its pharmacokinetic profile in children is crucial for safe and effective pain management.
Purpose of the Study:
- To determine the blood concentrations and pharmacokinetic parameters of bupivacaine after epidural injection in children aged 1 to 7 years.
- To compare these parameters with those of adults and assess safety after repeat dosing.
Main Methods:
- Children were divided into two groups for single or repeated epidural bupivacaine injections.
- Blood samples were collected to measure bupivacaine concentrations and calculate pharmacokinetic parameters (CPmax, Tmax, T1/2 abs, T1/2 beta, Vd, Clt).
Main Results:
- Pediatric pharmacokinetic parameters (Vd, Clt) were comparable to adults, with a similar terminal half-life (T1/2 beta).
- Repeat injections in Group 2 led to a significant increase in peak concentration (CPmax) but did not significantly alter other pharmacokinetic parameters.
- Mean peak concentrations remained below presumed toxic levels even after a second injection.
Conclusions:
- Bupivacaine pharmacokinetics in children aged 1-7 years are similar to adults.
- Recommended dosages appear safe for epidural use in children, even with repeat administrations.
Abstract:
Blood concentrations and pharmacokinetic parameters of bupivacaine were measured after epidural injection in children aged from 1 to 7 years. The children were allocated to two groups. In Group 1 (five children), pharmacokinetic parameters were measured after a single bolus injection of bupivacaine 0.25% with adrenaline 1:200,000. In Group 2 (eight children), pharmacokinetic parameters were measured after the initial injection and the second injection. The same local anaesthetic was used. The volume of the second injection was half of the initial volume. In children of Group 1, maximum mean concentration (CPmax) was 0.64 +/- 0.05 microgram ml-1, time to maximum concentration (Tmax) 19.2 +/- 3.9 min, vascular absorption (T1/2 abs) 4.3 +/- 1.5 min, terminal half-life (T1/2 beta) 227 +/- 37.7 min, volume of distribution (Vd) 3.4 +/- 0.51 kg-1, and total body clearance (Clt) 11.0 +/- 2.0 ml min-1 kg-1. When compared to an adult's pharmacokinetic parameters, both Vd and Clt were increased, so that T1/2 beta remained essentially unchanged. In children of Group 2, the first repeat injection was performed at 110 +/- 6.9 min. Mean CPmax increased significantly (20% after the second injection), whereas the values of the pharmacokinetic parameters measured did not differ significantly from those measured in children in Group 1. The results obtained in the present study demonstrate that the pharmacokinetic parameters of bupivacaine in children do not differ markedly from those reported in adults and that in the recommended dosage, the mean maximum concentrations, even after the second injection, are less than the presumed toxic levels.