British Journal of Anaesthesia, 2000, Vol. 85, No. 3 347-353
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia
Pharmacokinetics and clinical efficacy of long-term epidural ropivacaine infusion in children
1Department of Paediatric Anaesthesia, Princess Margaret Hospital for Children, Subiaco, 6001 Western Australia, Australia. 2Department of Pharmacology, University of Western Australia, Nedlands, 6907 Western Australia, Australia. 3Clinical Pharmacology & Toxicology Laboratory, The Western Australian Centre for Pathology & Medical Research, Nedlands, 6009 Western Australia, Australia
This article is acompanied by Editorial II.
The clinical efficacy and pharmacokinetics of long-term epidural ropivacaine infusion were investigated in 18 postoperative children aged between 0.3 and 7.3 yr. A lumbar or thoracic epidural catheter was inserted after the anaesthetic induction. Sixty minutes following a bolus dose of ropivacaine 1 mg kg–1, 0.2% ropivacaine was infused at a fixed rate of 0.4 mg kg–1 h–1 for a mean of 61.3 h (range 36–96 h). Clinical evaluation comprised hourly recording of pain, sedation, motor block, nausea/vomiting, pruritus-scores, SpO2, pulse and respiratory rates, and recording of non-invasive arterial pressure every 4 h. Total and free plasma concentrations were measured by high-performance liquid chromatography at 0, 1, 6, 12, 24, 36, 48, 72 and 96 h. Analgesia was of high quality and side effects were minor. No clinical signs of local anaesthetic toxicity were seen. Total (100–3189 µg litre–1) and free (10–56 µg litre–1) ropivacaine concentrations were within the range reported to be ‘safe’ in previous studies in adults. Mean (95% CI) volume of distribution was 3.1 litre kg–1 (2.1–4.2 litre kg–1), total clearance was 8.5 ml kg–1 min–1 (5.8–11.1 ml kg–1 min–1), free clearance was 220 ml kg–1 min–1 (170–270 ml kg–1 min–1) and elimination half-life was 4.9 h (3.0–6.7 h).
Br J Anaesth 2000; 85: 347–53
* Corresponding author: Department of Anaesthesia and Intensive Care, Odense University Hospital, DK-5000 Odense C, Denmark
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