Absorption characteristics of epidural levobupivacaine with adrenaline and clonidine in children

Chalkiadis, George; Abdullah, Farah Aini; Bjorksten, Andrew R.; Clarke, AE; Cortínez, Luis Ignacio; Udayasiri, Sonal; Anderson, Brian J.

doi:10.1111/pan.12074

Cited by 18 publications

(21 citation statements)

References 47 publications

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“…In contrast with the studies cited above [15,25,26], the time-course of plasma lidocaine concentration had quasi-straight absorption phase slopes with abrupt slope changes (Fig 7), a shape that resembles a short stepwise i.v. infusion and is suggestive of at least two zero-order absorption processes [29].…”

Section: Discussioncontrasting

confidence: 77%

“…One possible modification is to replace the dual first-order, asynchronous absorption rates with two zero-order, time-constrained absorption rates, a strategy tried for the PK modeling of the epidural block with levobupivacaine [15]. Although these investigators found that the goodness-of-fit of this alternative model was lower than their original model, other authors have found it useful to fit the i.m.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast with levobupivacaine [15] and ropivacaine in humans [25], the zero-order absorption rates (k 01 and k 02 ) of lidocaine, their respective durations (Dur 1 and Dur 2 ), and the lag time for the onset of the second absorption rate significantly differed between formulations ( P < 0.05). These changes in the absorption kinetics of lidocaine resulted in a significantly lower C max , hence a lower toxicity potential [34].…”

Section: Discussionmentioning

confidence: 99%

“…Among the few publications describing the effect of adrenaline on the pharmacokinetics of extravascular-administered local anesthetics, one used an interesting model to quantify the effect of adrenaline on the absorption of levobupivacaine following caudal epidural administration in children: these investigators fitted the drug’s time-concentration data to a model with two distinct first-order absorption rate constants whose onsets were separated by a lag time [15]. We hypothesized that this model could (1) be applied to other amide-type local anesthetics and extravascular administration sites, including the brachial plexus, and (2) accurately measure the lowering effects of adrenaline on the absorption rate of lidocaine.…”

Section: Introductionmentioning

confidence: 99%

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Pharmacokinetics of Lidocaine Hydrochloride Administered with or without Adrenaline for the Paravertebral Brachial Plexus Block in Dogs

et al. 2017

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Adrenaline is known to prolong the duration of local anesthesia but its effects on the pharmacokinetic processes of local anesthetic drugs are not fully understood. Our objective was to develop a compartmental model for quantification of adrenaline’s impact on the pharmacokinetics of perineurally-injected lidocaine in the dog. Dogs were subjected to paravertebral brachial plexus block using lidocaine alone or adrenalinated lidocaine. Data was collected through a prospective, randomised, blinded crossover protocol performed over three periods. Blood samples were collected during 180 minutes following block execution. Compartmental pharmacokinetic models were developed and their goodness-of-fit were compared. The lowering effects of adrenaline on the absorption of lidocaine were statistically determined with one-sided tests. A one-compartment disposition model with two successive zero-order absorption processes best fitted our experimental data. Adrenaline decreased the peak plasma lidocaine concentration by approximately 60% (P < 0.001), decreased this local anesthetic’s fast and slow zero-order absorption rates respectively by 50% and 90% (P = 0.046, and P < 0.001), which respective durations were prolonged by 90% and 1300% (P < 0.020 and P < 0.001). Lidocaine demonstrated a previously unreported atypical absorption profile following its paravertebral injection in dogs. Adrenaline decreased the absorption rate of lidocaine and prolonged the duration of its absorption.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pharmacokinetics of Lidocaine Hydrochloride Administered with or without Adrenaline for the Paravertebral Brachial Plexus Block in Dogs

et al. 2017

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“…Clonidine combined with levobupivacaine has a faster onset of sensory and motor block which was in accordance with Milligan KR et al 12 , Gupta S et al 13 and Jain A et al 14 Clonidine being a lipophilic drug is rapidly absorbed into the spinal compartment and blocks the conduction of C and Aδ fibres. 15 Chalkiadis DS et al 16 in their study demonstrated the absorption characteristics of epidural levobupivacaine with clonidine and adrenaline via caudal epidural route and showed that clonidine mixed with levobupivacaine had a faster absorption compared to adrenaline mixed with levobupivacaine.…”

Section: Discussionmentioning

confidence: 99%

Epidural levobupivacaine with clonidine prolongs anaesthesia and analgesia

Arumugam

Tandon

Choudhary

2016

Sri Lankan J Anaesthesiol

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Background: Epidural anaesthesia is a safe alternative for general anaesthesia in patients undergoing infraumbilical surgeries. This study was conducted to evaluate the effect of clonidine as an adjuvant to levobupivacaine, an S (-) enantiomer of bupivacaine. Material and Methods:Hundred patients of ASA grade I and II undergoing infraumbilical surgeries were randomized in two groups as L and LC. Group L received 0.5% levobupivacaine (1.5mg/kg) and group LC received 0.5% levobupivacaine (1.5mg/kg) with clonidine (2µg/kg). The onset time for sensory, motor blockade, duration of anaesthesia and duration of analgesia, VAS score were observed in both the groups. The haemodynamic variables such as heart rate, systolic and diastolic blood pressure, respiratory rate and SPO2 at various time intervals were measured. Any untoward side effects were noted in both groups. Results:The onset of sensory (7.8±1.7mins) and motor blockade (10.9±1.9mins) was significantly faster in clonidine group. Duration of anaesthesia and duration of analgesia was prolonged in group LC (234.5±16.1mins, 412.8±48.3mins) compared to group L (173.56±12.78 min, 269.2±24.2mins) which was statistically significant (p<0.05). Similarly clonidine group had less VAS score compared to control group. There was no significant change in the haemodynamic variables between the two groups. Hypotension and bradycardia was found more in clonidine group compared to the control group. Conclusion:Clonidine as an adjuvant to levobupivacaine prolongs the post-operative analgesia and the duration of anaesthesia for infraumbilical surgeries.

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Dexmedetomidine versus clonidine adjuvants to levobupivacaine for ultrasound‐guided transversus abdominis plane block in paediatric laparoscopic orchiopexy: Randomized, double‐blind study

Mostafa

Hamed

Amin

et al. 2020

European Journal of Pain

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BackgroundLaparoscopic surgeries are associated with less postoperative pain and adverse events compared to open procedures. But, it still reduces the quality of life in children. Transversus abdominis plane (TAP) block is used to reduce pain. We hypothesized that dexmedetomidine or clonidine could improve the analgesic profile of levobupivacaine to the same extent during TAP block in children.MethodsNinety children were randomly allocated in a randomized double‐blind trial to receive bilateral TAP block with levobupivacaine plus normal saline (group B, n = 30), or dexmedetomidine (group D, n = 30) or clonidine (group C, n = 30). Primary outcome was the modified Children's Hospital of Eastern Ontario Pain Scale score. Secondary outcomes included time to initial analgesic request, number of analgesic claims, total analgesic consumption, parents' satisfaction, sedation score and complications.ResultsChildren of group D showed reduced pain scores compared to other groups. They represented the longest period of analgesia (565.00 ± 71.5 min) with p < 0.001, and fewer patients required two doses of analgesia during the first postoperative day. The cumulative amount of backup analgesia was significantly different between these groups (p = 0.026). Higher parents’ satisfaction scores were recorded in groups D and C compared to group B. Sedation among the study groups revealed significant differences (p = 0.035), but no severe complications were recorded.ConclusionsAdding dexmedetomidine to levobupivacaine can extend the time of analgesia and reduce the use of postoperative backup analgesics with minimal sedation effects when used in TAP block in paediatrics undergoing laparoscopic orchiopexy. Clonidine can be used as an alternative adjuvant to local anaesthetics with good postoperative analgesic profiles.SignificanceClonidine can alternate dexmedetomidine during TAP block with local anesthetics for pediatrics laparoscopies. Both can lead to better postoperative analgesic profiles. Clonidine may be preferred, especially in our developing regions, because of its easy availability and lower cost than that of dexmedetomidine.

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Absorption characteristics of epidural levobupivacaine with adrenaline and clonidine in children

Cited by 18 publications

References 47 publications

Pharmacokinetics of Lidocaine Hydrochloride Administered with or without Adrenaline for the Paravertebral Brachial Plexus Block in Dogs

Pharmacokinetics of Lidocaine Hydrochloride Administered with or without Adrenaline for the Paravertebral Brachial Plexus Block in Dogs

Epidural levobupivacaine with clonidine prolongs anaesthesia and analgesia

Dexmedetomidine versus clonidine adjuvants to levobupivacaine for ultrasound‐guided transversus abdominis plane block in paediatric laparoscopic orchiopexy: Randomized, double‐blind study

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