Pharmacokinetics of ropivacaine in elderly patients receiving fascia iliaca compartment block

Abstract

Local anesthetic of ropivacaine was demonstrated to reduce the postoperative pain in elderly patients. This study investigated the pharmacokinetics of ropivacaine at different concentrations in elderly patients subjected to fascia iliaca compartment block. Forty patients with femoral neck fracture at American Society of Anesthesiologists (ASA) I–II status, undergoing fascia iliaca compartment block (FICB) were randomized to two groups receiving 0.7 ml/kg of solution containing 0.375% ropivacaine (group L) or 0.5% ropivacaine (group H). Samples of venous blood were obtained immediately at different time points after FICB, and the total and free plasma concentrations of ropivacaine were measured by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS). Statistical analysis was carried out using a pharmacokinetic calculation program (DAS 3.0). Visual Analogue Scale (VAS) scores were significantly decreased after FICB in both groups, and VAS score in group H was lower compared with group L. The total maximum plasma concentration (Cmax) and the free Cmax of ropivacaine in group H was higher than that in group L (P<0.05). The decrease of the total and free plasma concentration was operation time-dependent. Neither group showed signs of central nervous system and circulatory system toxicity. On the basis of these results, the concentrations of 0.375 and 0.5% ropivacaine held an efficiently analgesic effect for FICB, suggesting that ropivacaine can be employed in analgesic therapy. However, both concentrations have a potentially theoretical risk of local anesthetics poisoning, suggesting that a lower concentration may be a safer option for a single large volume of FICB.

Effect of fascia iliaca compartment block combined with ropivacaine on post-operative outcomes in elderly patients undergoing hip fracture repair

“…23 Ropivacaine is a local anesthetic with a propyl group on the third piperidine nitrogen atom; it blocks sodium ions from flowing into nerve fiber cell membranes, reversibly blocking impulse conduction, hyperpolarizing nerve cells, blocking signal transmission, and producing analgesic and sedative effects. 24,25 Our study demonstrated that while FICB procedure led to transient hemodynamic effect, as indicated by the rise in MAP and HR of the patients, ropivacaine in combination with FICB led to a significant reduction in the MAP and HR of patients after passive movement compared to parecoxib injection (p<0.005). Lower MAP and HR after passive movement were consistent over the extended period and remained significantly lower than that of the control group 24h after the surgery.…”

“… 23 Ropivacaine is a local anesthetic with a propyl group on the third piperidine nitrogen atom; it blocks sodium ions from flowing into nerve fiber cell membranes, reversibly blocking impulse conduction, hyperpolarizing nerve cells, blocking signal transmission, and producing analgesic and sedative effects. 24 , 25 …”

LC-MS/MS assisted biomonitoring of ropivacaine and 3-OH-ropivacaine after plane block anesthesia for cardiac device implantation

“…There are several methods published in scientific literature which describe the use of different types of analytical methodologies for biomonitoring, pharmacokinetic or forensic purposes ( Mathieu et al, 2006 ; Sawaki et al, 2009 ; Tonooka et al, 2016 ; Zhang et al, 2019 ; Lamy et al, 2020 ; Cui et al, 2023 ). In a recent publication, Cui et al ( Cui et al, 2023 ) describe an LC-MS method for quantification of ropivacaine in pig plasma which is very simple and quick, allowing for high-throughput analysis, however, the lack of an internal standard increases the possibility of erroneous measurements due to different types of systematic laboratory errors which can occur during sample preparation and due to technical limitations of the equipment.…”

Systemic Ropivacaine Concentrations Following Local Infiltration Analgesia and Femoral Nerve Block in Older Patients Undergoing Total Knee Arthroplasty

“…The concentrations reported by these studies are similar to those observed in group F of this study (0.303 to 1.157 μg mL −1 ). Zhang et al 12 used 3.5 mg/kg of ropivacaine (mean dose 210 mg) to perform fascia iliaca block, and reported substantially higher C max of 2.17 ± 0.56 μg mL −1 . In our study, the doses of ropivacaine ranged from 1.9 to 3.75 mg/kg, and only 4 patients received doses exceeding 3 mg/kg, so a lower C max would be expected.…”