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Serum bupivacaine concentrations during continuous extrapleural infusion
Summary
Continuous extrapleural infusion of bupivacaine after thoracotomy leads to a steady rise in total serum levels but not free levels. This study monitored bupivacaine concentrations over five days post-surgery.
Area of Science:
- Anesthesiology
- Pharmacology
- Thoracic Surgery
Background:
- Continuous extrapleural infusion is used for postoperative pain management.
- Understanding serum drug concentration is crucial for safety and efficacy.
- Bupivacaine is a common local anesthetic used in this setting.
Purpose of the Study:
- To quantify the rate of increase in serum bupivacaine concentration.
- To assess changes in both total and free bupivacaine levels.
- To evaluate the impact of continuous extrapleural infusion on serum drug levels over five days.
Main Methods:
- Extrapleural catheters were placed in nine patients undergoing thoracotomy.
- A continuous infusion of bupivacaine 0.5% with epinephrine was administered for five days.
- Serum bupivacaine (total and free), albumin, and alpha-1 acid glycoprotein were measured serially.
Main Results:
- Total serum bupivacaine concentration increased significantly from day 1 to day 4 (P < 0.05).
- Free serum bupivacaine concentration showed no significant increase (P = 0.92).
- Serum alpha-1 acid glycoprotein levels rose, while albumin levels remained stable.
Conclusions:
- Continuous extrapleural bupivacaine infusion results in a progressive rise in total serum concentrations.
- Free serum bupivacaine levels do not significantly increase, suggesting altered binding or metabolism.
- These findings are important for optimizing pain management strategies and patient safety.
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