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British Journal of Anaesthesia, 1991, Vol. 66, No. 1 25-30
© 1991 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

PLASMA CONCENTRATIONS OF BUPIVACAINE AND TWO OF ITS METABOLITES DURING CONTINUOUS INTERSCALENE BRACHIAL PLEXUS BLOCK

P. H. ROSENBERG, M.D., PH.D., P. PERE, M.D., R. HEKALI, M.SC. and M. TUOMINEN, M.D., PH.D.

Department of Anaesthesiology, Surgical Hospital, Helsinki University Central Hospital Helsinki, Finland

An interscalene brachial plexus block was performed via a catheter with 20–28 ml of 0.75% bupivacaine plus adrenaline for surgery of the shoulder region in 12 patients. Constant infusion of 0.25% bupivacaine 0.25 mg kg–1 h–1 was continued for 24 h. During surgery light general anaesthesia, without analgesics, was maintained. Plasma concentrations of total and unbound (free fraction) bupivacaine, desbutylbupivacaine (DBB), 4-hydroxybupivacaine (4-OHB) and alpha1-acid glycoprotein (AAG) were measured at predetermined intervals during the continuous block. The greatest mean plasma concentrations of bupivacaine were measured at 30 min (1.63 (SD 0.55) µg ml–1) and 60 min (1.38 (0.48) µg ml–1). There was a small but statistically significant increase in the plasma concentration of bupivacaine between 12 and 24 h of infusion. The mean unbound concentration of bupivacaine in plasma decreased from 0.044 (0.015) µg ml–1 (3.6 (1.1)% of total bupivacaine concentration) at 3 h to 0.023 (0.011) µg ml–1 (2.1 (1.0)%) at 24 h. The AAG concentration in plasma increased by 38% in 24 h. The metabolites DBB and 4-OHB were detectable in plasma from 30 min, with a gradual increase during infusion. At 24 h the mean concentrations of DBB and 4-OHB were 0.33 (0.22) µg ml–1 and 0. 13 (0.04) µg ml–1, respectively. There were no toxic reactions during the blocks.


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