Perioperative Analgesic Efficacy and Plasma Concentrations of S(+)-Ketamine in Continuous Epidural Infusion During Thoracic Surgery

2013 ◽  
Vol 116 (6) ◽  
pp. 1371-1375 ◽  
Author(s):  
Paolo Feltracco ◽  
Stefania Barbieri ◽  
Stefano Rizzi ◽  
Carlo Ori ◽  
Francesca Groppa ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Plasma Concentrations ◽  
Analgesic Efficacy ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion

Perioperative Analgesic Efficacy and Plasma Concentrations of S(+)-Ketamine in Continuous Epidural Infusion During Thoracic Surgery

2014 ◽  
Vol 58 (2) ◽  
pp. 64
Author(s):  
Paolo Feltracco ◽  
Stefania Barbieri ◽  
Stefano Rizzi ◽  
Carlo Ori ◽  
Francesca Groppa ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Plasma Concentrations ◽  
Analgesic Efficacy ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion

Pharmacokinetics of Bupivacaine during Postoperative Epidural Infusion

2002 ◽  
Vol 96 (5) ◽  
pp. 1062-1069 ◽  
Author(s):  
Bernadette Th. Veering ◽  
Anton G. L. Burm ◽  
Hilde-Marieken Feyen ◽  
Wim Olieman ◽  
John H. M. Souverijn ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Protein Binding ◽  
Bolus Dose ◽  
Plasma Concentrations ◽  
Epidural Infusion ◽  
Total Plasma ◽  
Continuous Epidural Infusion ◽  
Acid Glycoprotein ◽  
Constant Rate

Background Changing plasma protein concentrations may affect the protein binding and pharmacokinetics of drugs in the postoperative period. This study examined the effect of postoperative increases (in response to surgery) in plasma alpha1-acid-glycoprotein (AAG) concentrations on the plasma concentrations of the enantiomers of bupivacaine during continuous epidural infusion of racemic bupivacaine for postoperative pain relief. Methods Six patients scheduled for total hip surgery with combined epidural and general anesthesia received a bolus dose of bupivacaine (65 mg) followed by constant-rate (8 ml/h) epidural infusion of 2.5 mg/ml bupivacaine for 48 h. Total and unbound plasma concentrations of the enantiomers of bupivacaine and plasma AAG concentrations during the 48-h epidural infusion were determined. Results Total plasma concentrations of the enantiomers of bupivacaine increased steadily during the infusion (P < 0.0001), whereas unbound concentrations did not change after 12 h (P > 0.1). Total plasma concentrations of S(-)-bupivacaine were higher than those of R(+)-bupivacaine (P < 0.02), whereas unbound concentrations of S(-)-bupivacaine were lower than those of R(+)-bupivacaine (P < 0.002). AAG concentrations initially decreased, but thereafter increased steadily (P < 0.0001). Consequently, free fractions of the enantiomers initially increased and then decreased with time (P = 0.0002). Free fractions of S(-)-bupivacaine were smaller than those of R(+)-bupivacaine (P = 0.0003). Conclusions The study confirmed that the pharmacokinetics of bupivacaine are enantioselective. During postoperative epidural infusion, changing plasma AAG concentrations affect the protein binding of both enantiomers of bupivacaine. Consequently, total plasma concentrations of the enantiomers increase with time, whereas unbound concentrations reach a plateau.

Efficacy, Safety, and Pharmacokinetics of Levobupivacaine with and without Fentanyl after Continuous Epidural Infusion in Children

2003 ◽  
Vol 99 (5) ◽  
pp. 1166-1174 ◽  
Author(s):  
Jerrold Lerman ◽  
Judith Nolan ◽  
Rob Eyres ◽  
Mark Schily ◽  
Peter Stoddart ◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Venous Blood ◽  
Plasma Concentrations ◽  
Epidural Infusion ◽  
Healthy Children ◽  
Rescue Analgesia ◽  
Continuous Epidural Infusion ◽  
Number Of Children ◽  
Intention To Treat ◽  
Double Blinded

Background Levobupivacaine, the levo-enantiomer of bupivacaine, is as potent as bupivacaine but less toxic. Therefore, the authors investigated the efficacy, safety, and pharmacokinetics of perioperative epidural levobupivacaine with and without fentanyl in children. Methods After Research Ethics Board approval and informed written consent, 120 healthy children aged 6 months to 12 yr who were scheduled to undergo urologic or abdominal surgery were randomized in a double-blinded and concealed manner to receive one of four epidural solutions as a continuous infusion for 24 h: 0.125% levobupivacaine; 0.0625% levobupivacaine; 1 mug/ml fentanyl; or the combination, 0.0625 levobupivacaine and 1 mug/ml fentanyl. After induction of anesthesia and tracheal intubation, a lumbar epidural catheter was sited, a loading dose was administered (0.75 ml/kg levobupivacaine, 0.175%), and the epidural infusion was commenced. The primary endpoint was the need for rescue analgesia (morphine) in the first 10 h after surgery. Pain, motor strength, and side effects were recorded for 24 h. Venous blood was collected from 18 children to determine the plasma concentrations of levobupivacaine and/or fentanyl before and 2, 4, 8, 16, 24, and 26 or 30 h after the start of the epidural infusion. Results Of the 114 children who were analyzed for intention to treat, a similar number of children in each group reached the 10-h mark. The time to the first dose of morphine in the first 10 h was less in the plain fentanyl group (P < 0.044). All other effects were similar among the four groups. The plasma concentration of levobupivacaine increased during the infusion period, reaching a maximum of 0.76 +/- 0.11 mug/ml in the 0.125% group and 0.48 +/- 0.12 mug/ml in the 0.0625% group by 24 h. The plasma concentration of fentanyl also increased steadily, reaching a maximum concentration of 0.37 +/- 0.11 ng/ml by 24 h. Conclusion We conclude that 0.0625% levobupivacaine without fentanyl is an effective perioperative epidural solution in children when infused at a rate of 0.3 ml. kg-1. h-1. The plasma concentrations of 0.125% and 0.0625% levobupivacaine and fentanyl (1 mug/ml) at the end of a 24-h infusion are low.

Pharmacokinetics and Analgesic Effect of Ropivacaine during Continuous Epidural Infusion for Postoperative Pain Relief

1996 ◽  
Vol 84 (4) ◽  
pp. 834-842. ◽  
Author(s):  
Carl-Johan Erichsen ◽  
Jan Sjovall ◽  
Henrik Kehlet ◽  
Cecilia Hedlund ◽  
Torbjorn Arvidsson
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Plasma Concentrations ◽  
Epidural Infusion ◽  
Postoperative Pain Relief ◽  
Total Plasma ◽  
Analog Scale ◽  
Continuous Epidural Infusion ◽  
Unbound Fraction

Background The pharmacokinetics and clinical efficacy of ropivacaine (2.5 mg/ml) during a 24-h continuous epidural infusion for postoperative pain relief in 20 patients scheduled for abdominal hysterectomy were characterized using an open-label, increasing-dose design. Methods Through an epidural catheter inserted at T10-T12, a test dose of 7.5 mg ropivacaine was given 3 min before a bolus dose of 42.5 mg and immediately followed by a 24-h continuous epidural infusion with either 10 or 20 mg/h. Peripheral venous plasma samples were collected up to 48 h after infusion, and urinary excretion was followed up to the end of infusion. Postoperative pain at rest, on coughing, and at mobilization was assessed by means of a visual analog scale 2,4,6,8,12, and 24 h after the end of surgery. Sensory (pinprick) and motor block (modified Bromage scale) were assessed at the same intervals. Results The total plasma concentrations of ropivacaine increased markedly and consistently during the 24-h epidural infusion, in contrast to stable unbound concentrations. Both total and unbound plasma concentrations at the end of infusion were proportional to the total dose, although only the latter was proportional to the infusion rate. The total and unbound plasma clearance was independent of dose. Total mean clearance decreased on average by 21% (P < 0.001) during the last 12 h of epidural infusion, i.e., from 539 +/- 191 ml/min to 418 +/- 138 ml/min, indicating time-dependent kinetics. The unbound clearance also varied between estimates after 8 h of infusion and the end of treatment, i.e., a 5.3% decrease from 10.4 +/- 5.3 l/min to 9.5 +/- 3.9 l/min (P < 0.05). The unbound fraction of ropivacaine in plasma decreased during treatment, and this was related to the increase in alpha1-acid glycoprotein concentration. Pain was generally well controlled, and median visual analog scale scores during mobilization were less than 30 mm in patients receiving ropivacaine at 20 mg/h. Conclusions The pharmacokinetics of ropivacaine were independent of dose, but total clearance decreased with time over 24 h. The consistent increase in total plasma concentration during the postoperative epidural infusion contrasted to much less variation in the unbound plasma concentrations of ropivacaine.

Plasma Concentrations of Lidocaine and Its Principal Metabolites During Continuous Epidural Infusion of Lidocaine With or Without Epinephrine

1999 ◽  
Vol 24 (6) ◽  
pp. 529-533 ◽  
Author(s):  
Shin-ichi Kihara ◽  
Masayuki Miyabe ◽  
Yoshihiro Kakiuchi ◽  
Shinji Takahashi ◽  
Taeko Fukuda ◽  
...  
Keyword(s):  
Plasma Concentrations ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion

scholarly journals Continuous epidural infusion of racemic methadone results in effective postoperative analgesia and low plasma concentrations

2002 ◽  
Vol 49 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Pilar Prieto-Alvarez ◽  
Isabel Tello-Galindo ◽  
Jesus Cuenca-Peña ◽  
Maria Rull-Bartomeu ◽  
Carmen Gomar-Sancho
Keyword(s):  
Postoperative Analgesia ◽  
Plasma Concentrations ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion
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