British Journal of Anaesthesia, Vol 76, Issue 3 452-455, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
T. Smith, P. Moratin and H. Wulf
We have measured plasma concentrations of bupivacaine after ilioinguinal
block in children of different sizes. We studied 14 children with weights
10-15 kg and 17 children with weights 15-30 kg. Each child received 0.5%
bupivacaine 0.25 ml kg-1 (1.25 mg kg-1) (Carbostesin, Astra, Germany).
Venous blood was obtained before the block (control) and at 5, 10, 15, 20,
30 and 60 min after block. Mean maximal concentration in the 10-15-kg group
(1.5 (SD 0.9) mg litre-1, range 0.43-4.0 mg litre-1, at 18 (5) min) was
significantly higher (P < 0.05) than that in the 15-30-kg group (0.9
(0.3) mg litre-1 range 0.35- 1.34 mg litre-1, at 16 (5) min). In the
10-15-kg group, unexpectedly high (up to 4 mg litre-1) bupivacaine
concentrations were observed and often concentrations remained high (> 2
mg litre-1) at 60 min. We conclude that smaller children appear to differ
in the pharmacokinetic handling of bupivacaine. The maximum safe plasma
concentration of bupivacaine in small children, although not clearly
established, is likely to be approximately 4 mg litre-1. We recommend,
therefore, that a dose of bupivacaine 1.25 mg kg-1 should not be exceeded
in the perioperative period when performing ilioinguinal block in children
< 15 kg in weight.
SHORT COMMUNICATIONS
Smaller children have greater bupivacaine plasma concentrations after ilioinguinal block
Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Schwanenweg, 24105 Kiel, Germany
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