Related Experiment Videos
Bupivacaine plasma concentrations during continuous epidural anesthesia in infants and children
G Luz1, P Innerhofer, B Bachmann
1Department of Anesthesia, University Hospital, Innsbruck, Austria.
Insights
Younger infants (up to 4 months) exhibit higher venous bupivacaine plasma concentrations than older children after continuous epidural infusion. This highlights age-related differences in bupivacaine pharmacokinetics in pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
- Pharmacokinetics
Background:
- Bupivacaine is a commonly used local anesthetic in pediatric surgical procedures.
- Understanding bupivacaine pharmacokinetics is crucial for safe and effective pain management in neonates and infants.
- Limited data exists on plasma concentrations of bupivacaine in very young infants receiving continuous epidural infusions.
Purpose of the Study:
- To compare venous bupivacaine plasma concentrations in neonates and infants (4 days to 3.9 months) versus older infants and children (9 months to 6 years).
- To evaluate the impact of age on bupivacaine plasma levels following a standardized epidural administration protocol.
Main Methods:
- A prospective study involving two age groups: neonates/infants (4 days-3.9 months) and older infants/children (9 months-6 years).
- All participants received an initial bolus of bupivacaine 0.25% (0.5 mL/kg) followed by a 4-hour continuous epidural infusion.
- Plasma bupivacaine concentrations were measured at 180 and 300 minutes post-administration.
Main Results:
- Significantly higher plasma bupivacaine concentrations were observed in younger infants compared to older children at both 180 minutes (0.67 vs 0.27 µg/mL, P < 0.01) and 300 minutes (0.86 vs 0.34 µg/mL, P < 0.01).
- Despite identical dosing, infants under 4 months showed higher peak plasma levels than children over 9 months.
- Individual plasma concentration ranges indicated substantial variability within each group.
Conclusions:
- Age is a significant factor influencing bupivacaine plasma concentrations in pediatric patients receiving continuous epidural infusions.
- Younger infants (< 4 months) achieve higher systemic exposure to bupivacaine compared to older children, necessitating careful consideration of dosing and monitoring.
- These findings underscore the importance of age-specific pharmacokinetic data for optimizing local anesthetic use in pediatric anesthesia.
Abstract:
Venous bupivacaine plasma concentrations were measured in six neonates and infants aged 4 days to 3.9 mo (mean, 2.1 mo) and 10 infants and children aged 9 mo to 6 yr (mean, 3.1 yr) after administration of an initial bolus of 0.5 mL/kg bupivacaine 0.25%, followed by a continuous infusion of local anesthetic (0.25 mL.kg-1.h-1) over a period of 4 h (first hour: bupivacaine 0.25%, then reduced to 0.125%). Plasma concentrations of local anesthetic measured at 180 min and 300 min after beginning of bupivacaine administration were significantly higher in younger infants when compared to older infants and children (180 min: 0.67 +/- 0.24 micrograms/mL [0.25-0.97] vs 0.27 +/- 0.11 micrograms/mL [0.19-0.55], P < 0.01; 300 min: 0.86 +/- 0.36 micrograms/mL [0.35-1.25] vs 0.34 +/- 0.12 micrograms/mL [0.18-0.57], P < 0.01). The results of our study show that despite applying the same dosage of epidural bupivacaine significantly higher plasma concentrations were seen after short periods of continuous infusion in infants up to 4 mo than in children older than 9 mo.