Related Experiment Video

Updated: Aug 7, 2026

Guidelines for Elective Pediatric Fiberoptic Intubation
11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

Bupivacaine for intercostal nerve blocks in children: blood concentrations and pharmacokinetics

P Rothstein, G R Arthur, H S Feldman

    Anesthesia and Analgesia
    |June 1, 1986
    PubMed

    Insights

    This study found that children have a greater volume of distribution and faster clearance of bupivacaine compared to adults after intercostal nerve blocks. Researchers recommend reporting whole blood concentrations due to hematocrit influencing plasma levels.

    Area of Science:

    • Pharmacology and Toxicology
    • Pediatric Anesthesiology
    • Clinical Pharmacokinetics

    Background:

    • Intercostal nerve blocks are used for pediatric pain management.
    • Understanding bupivacaine pharmacokinetics in children is crucial for safe dosing.
    • Limited data exists on bupivacaine absorption and disposition in pediatric populations.

    Purpose of the Study:

    • To evaluate the pharmacokinetics of bupivacaine following intercostal nerve blocks in children.
    • To compare pediatric pharmacokinetic parameters with those reported in adult patients.
    • To investigate the relationship between hematocrit and bupivacaine blood:plasma concentration ratio in children.

    Main Methods:

    • Pharmacokinetic analysis of bupivacaine in 27 children (3 months-16 years) receiving intercostal nerve blocks.
    • Administration of bupivacaine HCl 0.5% with epinephrine 1:200,000 at doses of 2, 3, and 4 mg/kg.
    • Measurement of whole blood arterial bupivacaine concentrations and calculation of pharmacokinetic parameters (VD beta, VDss, t1/2 beta, Cl).
    • Investigation of bupivacaine blood:plasma concentration ratio (lambda) versus hematocrit in an additional 11 children.

    Main Results:

    • Peak whole blood bupivacaine concentrations ranged from 0.77 to 1.87 µg/mL across the studied doses.
    • Children exhibited a greater volume of distribution (VD beta, VDss) and faster total body clearance (Cl) compared to adults.
    • Absorption from the intercostal space appeared more rapid in children.
    • A significant inverse relationship was found between the bupivacaine blood:plasma concentration ratio (lambda) and hematocrit (lambda = -0.0079 Hct + 1.028).

    Conclusions:

    • Pediatric patients demonstrate distinct bupivacaine pharmacokinetic profiles, characterized by increased volume of distribution and clearance.
    • Rapid absorption from the intercostal site in children warrants careful dose consideration.
    • Hematocrit significantly influences the bupivacaine blood:plasma concentration ratio, suggesting whole blood concentrations are preferable for reporting to avoid reporting artifacts.

    More Related Videos

    Non-Intubated Video-Assisted Thoracoscopic Surgery05:39

    Non-Intubated Video-Assisted Thoracoscopic Surgery

    Published on: May 26, 2023

    Lumbar Intrathecal Injection of Gene Therapy Vectors for Central Nervous System Targeting in Mice and Rats05:09

    Lumbar Intrathecal Injection of Gene Therapy Vectors for Central Nervous System Targeting in Mice and Rats

    Published on: May 16, 2025

    Related Concept Videos

    Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics01:11

    Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics

    All neuromuscular blocking agents are injected intravenously because they are poorly absorbed from the GI tract. Rapid onset is achieved with intravenous administration, although absorption is also adequate from an intramuscular injection. Since these agents are highly ionized, they do not readily penetrate cell membranes or cross the blood-brain barrier.
    Instead, they are transported by the blood to different tissues. Muscles with a greater blood supply (arteries) and blood flow receive more...
    Depolarizing Blockers: Pharmocokinetics01:19

    Depolarizing Blockers: Pharmocokinetics

    Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
    Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

    Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

    Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
    One of the advantages of...
    Drug Dosing: Infants and Children01:29

    Drug Dosing: Infants and Children

    Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
    Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

    Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

    Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
    Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

    Pharmacokinetics in Pediatric Patients: Drug Distribution

    Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight, compared...