In children, the addition of epinephrine modifies the pharmacokinetics of ropivacaine injected caudally

Obbergh, Luc Van; Roelants, Fabienne; Veyckemans, Francis; Verbeeck, Roger K.

doi:10.1007/bf03018647

Cited by 19 publications

(12 citation statements)

References 20 publications

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“…These concentrations were reduced compared to plain levobupivacaine for up to 3.5 hours. Similar profiles have been reported for epidural ropivacaine in adults and children with and without adrenaline. This alteration in disposition is thought to decrease toxic potential .…”

Section: Discussionsupporting

confidence: 82%

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Absorption characteristics of epidural levobupivacaine with adrenaline and clonidine in children

Chalkiadis

Abdullah

Bjorksten

et al. 2012

Pediatric Anesthesia

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The addition of adrenaline decreases the rate of levobupivacaine systemic absorption, reducing peak concentration by half. Levobupivacaine concentrations with adrenaline adjuvant were reduced compared to plain levobupivacaine for up to 3.5 hours. Clonidine as an adjuvant results in faster systemic absorption of levobupivacaine and similar concentration time profile to levobupivacaine alone. Adding adrenaline with clonidine does not alter the concentration profile observed with adrenaline alone.

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Section: Discussionsupporting

confidence: 82%

“…The vasoconstrictor effects of adrenaline reduce systemic absorption involved in epidural disposition of ropivacaine and bupivacaine . These are postulated to increased local anesthetic uptake into the intrathecal space causing a more pronounced analgesic effect .…”

Section: Discussionmentioning

confidence: 99%

Absorption characteristics of epidural levobupivacaine with adrenaline and clonidine in children

Chalkiadis

Abdullah

Bjorksten

et al. 2012

Pediatric Anesthesia

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show abstract

“…30 Body weight was also reported as a significant covariate for total clearance and volume of distribution. 32 Post-menstrual age is preferred to post-natal age to describe maturation of physiological function. 33 In particular, it acknowledges that maturation is occurring before birth.…”

Section: Discussionmentioning

confidence: 99%

Population pharmacokinetic analysis of ropivacaine and its metabolite 2′,6′-pipecoloxylidide from pooled data in neonates, infants, and children

Aarons

Sadler²,

Pitsiu³

et al. 2011

British Journal of Anaesthesia

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“…13 Ropivacaine is known to cause less postoperative motor blockade than bupivacaine. 18,45 Its systemic absorption from the caudal epidural space is prolonged, but can be further extended by addition of epinephrine, 46 to be diluted at a 1:200 000 ratio. 41…”

Section: Bupivacaine Vs Ropivacainementioning

confidence: 99%

Caudal epidural blocks in paediatric patients: a review and practical considerations

Wiegele

Marhofer

Lönnqvist

2019

British Journal of Anaesthesia

151

137

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Caudal epidural blockade in children is one of the most widely administered techniques of regional anaesthesia. Recent clinical studies have answered major pharmacodynamic and pharmacokinetic questions, thus providing the scientific background for safe and effective blocks in daily clinical practice and demonstrating that patient selection can be expanded to range from extreme preterm births up to 50 kg of body weight. This narrative review discusses the main findings in the current literature with regard to patient selection (sub-umbilical vs mid-abdominal indications, contraindications, low-risk patients with spinal anomalies); anatomical considerations (access problems, age and body positioning, palpation for needle insertion); technical considerations (verification of needle position by ultrasound vs landmarks vs 'whoosh' or 'swoosh' testing); training and equipment requirements (learning curve, needle types, risk of tissue spreading); complications and safety (paediatric regional anaesthesia, caudal blocks); local anaesthetics (bupivacaine vs ropivacaine, risk of toxicity in children, management of toxic events); adjuvant drugs (clonidine, dexmedetomidine, opioids, ketamine); volume dosing (dermatomal reach, cranial rebound); caudally accessed lumbar or thoracic anaesthesia (contamination risk, verifying catheter placement); and postoperative pain. Caudal blocks are an efficient way to offer perioperative analgesia for painful sub-umbilical interventions. Performed on sedated children, they enable not only early ambulation, but also periprocedural haemodynamic stability and spontaneous breathing in patient groups at maximum risk of a difficult airway. These are important advantages over general anaesthesia, notably in preterm babies and in children with cardiopulmonary co-morbidities. Compared with other techniques of regional anaesthesia, a case for caudal blocks can still be made.

show abstract

In children, the addition of epinephrine modifies the pharmacokinetics of ropivacaine injected caudally

Cited by 19 publications

References 20 publications

Absorption characteristics of epidural levobupivacaine with adrenaline and clonidine in children

Absorption characteristics of epidural levobupivacaine with adrenaline and clonidine in children

Population pharmacokinetic analysis of ropivacaine and its metabolite 2′,6′-pipecoloxylidide from pooled data in neonates, infants, and children

Caudal epidural blocks in paediatric patients: a review and practical considerations

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