Levobupivacaine plasma concentrations following repeat caudal anesthetics
- Resource Type
- Authors
- Geoff Frawley; Luis Ignacio Cortinez; Brian J. Anderson; Andrew Bjorksten; Sebastian King
- Source
- Paediatric anaesthesiaREFERENCES. 32(12)
- Subject
- Anesthesiology and Pain Medicine
Adolescent
Pediatrics, Perinatology and Child Health
Infant, Newborn
Infant
Humans
Anesthetics, Local
Child
Bupivacaine
Anesthesia, Caudal
Anesthesia, Spinal
Levobupivacaine
- Language
- ISSN
- 1460-9592
A single caudal anesthetic at the start of lower abdominal surgery is unlikely to provide prolonged analgesia. A second caudal at the end of the procedure extends the analgesia duration but total plasma concentrations may be associated with toxicity. Our aim was to measure total plasma levobupivacaine concentrations after repeat caudal anesthesia in infants and to generate a pharmacokinetic model for prediction of plasma concentrations after repeat caudal anesthesia in neonates, infants and children.Infants undergoing definitive repair of anorectal malformations or Hirschsprung's disease received a second caudal anesthesia at the end of the procedure. Total levobupivacaine concentrations were assayed 3-4 times in the first 6 h after the initial caudal. These data were pooled with data from four studies describing plasma concentrations after levobupivacaine caudal or spinal anesthesia. Population pharmacokinetic parameters were estimated using nonlinear mixed-effects models. Covariates included postmenstrual age and body weight. Parameter estimates were used to simulate concentrations after a repeat levobupivacaine 2.5 mg kgTwenty-one infants (postnatal age 11-32 weeks, gestation 37-39 weeks, weight 5.2-8.6 kg) were included. The measured peak plasma concentration after repeat caudal levobupivacaine 2.5 mg kgRepeat caudal levobupivacaine 2.5 mg kg