Analgesic Efficacy Of Transversus Abdominis Plane Block In Neonates And Early Infants For Colostomy And Reversal Of Colostomy

Chen, Chee Kean; Teo, Shu Ching; Phui, Vui Eng; Saman, Mat Ariffin

doi:10.5505/agri.2015.66487

Cited by 2 publications

(1 citation statement)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Levobupivacaine 0.25% can be administered with doses ranging up to 1 mL/kg [4,5,7,[12][13][14][15].These recommendations are rarely based on pharmacokinetic data. Previous studies with ropivacaine showed an influence of the injected volume on the effectiveness of regional anaesthesia [6,16] while no study investigated the influence of the injected volume of levobupivacaine during a TAP block.…”

Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics of Levobupivacaine During Transversus Abdominis Plane Block in Children

Vincent

Mathieu

Nolain

et al. 2020

Therapeutic Drug Monitoring

View full text Add to dashboard Cite

+33 4 11 75 95 75Conflict of Interests None to declare. AbstractBackground: Levobupivacaine is commonly used in transversus abdominis plane block in paediatrics.However, dosing regimen is still empirical and is currently not relied on pharmacokinetic properties of levobupivacaine. We described pharmacokinetics of levobupivacaine during an ultrasound-guided transversus abdominis plane block in order to optimize dosing regimen, according to the between subject variability and the volume of levobupivacaine injected. Method:The clinical trial (prospective, randomized, double-blind study protocol) was conducted in 40 children from 1 to 5 years old and planned for inguinal surgery. Each patient received 0.4 mg/kg of levobupivacaine with a volume of the local anaesthesia solution adjusted to 0.2 mL/kg of 0.2% or 0.4 mL/kg of 0.1% levobupivacaine. Blood samples were collected at 5,15, 20, 25, 30, 45, 60 and 75 min following the block injection. The population pharmacokinetic analysis was performed with the NONMEM software.Results: From the pharmacokinetic parameters obtained, median Cmax, tmax and area under the concentration versus time curve were respectively evaluated to 0.315 mg/L, 17 min and 41 mg/L. min.Between subject variability (BSV) of clearance is explained by the weight. The volume of the local anaesthesia injected influences bioavailability and so systemic concentration. At the dose regimen of 0.4 mg/kg, none of the infants presented toxicity signs, but for 13 patients transversus abdominis plane block failed. After analysis, BSV for absorption rate constant, distribution volume and clearance were 81%, 47% and 41% respectively. Residual unexplained variability was estimated to 14%. Conclusion:Results suggest that, for a better efficiency in paediatric population, the dose of levobupivacaine should be greater than 0.4 mg/kg and the volume of solution injected must be high.Children's' weight should be considered to anticipate any risk of toxicity.

show abstract