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[Plasma concentrations of bupivacaine for continuous peridural anesthesia in children]
A Scherhag1, P P Kleemann, S Vrana
1Klinik für Anästhesiologie der Johannes Gutenberg-Universität Mainz.
Insights
Continuous epidural anesthesia using bupivacaine in children for lower body surgery is safe. Postoperative plasma bupivacaine levels remained below toxic thresholds, indicating effective pain management without adverse effects.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Epidural anesthesia is effective for pediatric postoperative analgesia.
- Limited data exist on long-term effects of epidural anesthesia in children.
- Understanding bupivacaine pharmacokinetics is crucial for safe pediatric pain management.
Purpose of the Study:
- To assess plasma bupivacaine levels in children receiving continuous epidural anesthesia postoperatively.
- To evaluate the safety and efficacy of continuous epidural infusion of bupivacaine in pediatric patients.
Main Methods:
- Ten pediatric patients undergoing lower body surgery received continuous epidural infusion of bupivacaine (max 0.4 mg/kg/h).
- Plasma bupivacaine concentrations were measured daily.
- Serum albumin and alpha 1-acid glycoprotein levels were monitored.
- Patients were closely monitored for signs of local anesthetic intoxication.
Main Results:
- Maximum bupivacaine plasma levels were 0.5 mcg/ml after loading dose and up to 2.2 mcg/ml during continuous infusion.
- Albumin and alpha 1-acid glycoprotein levels were within normal ranges.
- No neurologic complications or signs of local anesthetic toxicity were observed.
Conclusions:
- Continuous epidural infusion of bupivacaine at doses up to 0.4 mg/kg/h is safe for pediatric postoperative pain management.
- The study demonstrates no association with toxic complications in children.
- Close monitoring by experienced staff is essential for safe administration.
Abstract:
Epidural anaesthesia is extremely useful in providing postoperative analgesia for children after surgery of the lower body. Although results on early pharmacokinetics in children have previously been reported, no data are available on the long-term effects of epidural anaesthesia. The aim of this investigation was the assessment of plasma bupivacaine levels in children with continuous epidural anaesthesia in the postoperative period. A catheter with an outer diameter of 0.63 mm was inserted through a 19G Tuohy cannula into the epidural space. A maximum dose of 0.4 mg/kg/h bupivacaine was administered for continuous epidural infusion. Careful monitoring was performed to detect early signs of local anaesthetic intoxication. Two milliliters of blood were obtained in each patient per day and nepholometric serum measurement were performed to determine alpha 1-acid glycoprotein and albumin levels. Bupivacaine plasma concentrations were assessed according to the method described by Sattler et al. [25]. Ten children were included in the investigation. The measured albumin and alpha 1-acid glycoprotein concentrations were within the range described by other investigators. At the onset of pain therapy maximum levels of 0.5 microgram/ml were recorded after a loading dose of bupivacaine and levels of up to 2.2 micrograms/ml were achieved following continuous infusion. There were no neurologic complications or signs of local anesthetic intoxication. In conclusion our results show that a dose of up to 0.4 mg/kg/h bupivacaine during continuous epidural infusion is not associated with toxic complications. Careful monitoring of the children by experienced staff is mandatory.