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British Journal of Anaesthesia, Vol 79, Issue 1 9-13, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Serum concentrations of bupivacaine during prolonged continuous paravertebral infusion in young infants

SLW. Cheung, P. D. Booker, R. Franks and M. Pozzi
Royal Liverpool Children's NHS Trust, Eaton Road, Liverpool L12 2AP

We have studied the efficacy of prolonged, continuous paravertebral infusion of bupivacaine for the management of post-thoracotomy pain in 22 infants with a median age of 1.5 weeks (range 1 day to 20.4 weeks). Immediately before chest closure, 0.25% bupivacaine 1.25 mg kg-1 was given into an extrapleural paravertebral catheter, inserted under direct vision. Subsequently, 0.125% bupivacaine with adrenaline 1:400000 was infused at a rate of 0.2 ml kg-1 h-1 for 48 h. We confirmed that extrapleural paravertebral catheter placement under direct vision was easy in neonates and infants. The technique provided effective post-operative pain relief in 86% of patients, with three patients requiring morphine in addition. Mean serum concentration of bupivacaine after 48 h was 1.60 (0.67) micrograms ml-1, but bupivacaine concentrations > 3 micrograms ml-1 were found in three patients at 30- 48 h. There were no major complications relating to the technique, and paravertebral block was an effective method of providing prolonged post- thoracotomy analgesia in these young infants.
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