Ropivacaine Undergoes Slower Systemic Absorption from the Caudal Epidural Space in Children than Bupivacaine

Karmakar, Manoj K.; Aun, C. S. T.; Wong, Eliza Lai Yi; Wong, April S. Y.; Chan, Sze-Chun; Yeung, Chung Kwong

doi:10.1097/00000539-200202000-00006

Cited by 41 publications

(46 citation statements)

References 25 publications

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“…The slower absorption of ropivacaine from the caudal space when compared to bupivacaine has been described recently. 15 Its absorption from the epidural space is slow and has been described as biphasic; this is related to the high partitioning of ropivacaine into fat. 16 Although the T max observed in the epinephrinegroup was similar to those obtained in other studies (Table IV), we found a greater C max .…”

Section: Part 2: Population Analysis Using Nonmemmentioning

confidence: 99%

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

et al. 2003

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Section: Part 2: Population Analysis Using Nonmemmentioning

confidence: 99%

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

et al. 2003

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“…The most common volume of local anaesthetic solution used for paediatric operation below the T10 dermatone level is 1 ml.kg )1 [3,[7][8][9][10]. In previous reports [3,[7][8][9][10], the concentrations of ropivacaine used in paediatric caudal blockade ranged from 0.1% to 0.5%. Toxic drug complications of local anaesthetics have been reported following caudal analgesia [18,19].…”

Section: Discussionmentioning

confidence: 99%

Minimum local analgesic concentration of ropivacaine for intra‐operative caudal analgesia in pre‐school and school age children

et al. 2010

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SummaryWe compared the minimum local analgesia concentration of ropivacaine for intra-operative caudal analgesia in pre-school and school age children. Fifty-one boys, undergoing hypospadius repair surgery, were stratified into pre-school or school age groups. After induction of anaesthesia, caudal block was performed with ropivacaine 1 ml.kg )1 of the desired concentration. The first child in each group received ropivacaine 0.125%, and subsequent concentrations were determined by the analgesic response of the previous patient using Dixon's up-and-down method. Under general anaesthesia with 0.7 minimum alveolar concentration of sevoflurane, the minimum local analgesia concentration of ropivacaine for intra-operative caudal block was 34% greater in school age than in pre-school age boys (0.143% (95% CI 0.132-0.157%) vs 0.107% (95% CI 0.089-0.122%), respectively; p < 0.001). This study indicates that a higher concentration of ropivacaine is needed for school age than pre-school age children to provide intra-operative caudal analgesia when combined with general anaesthesia. Caudal block is usually performed under general anaesthesia for intra-operative and postoperative pain relief in paediatric, urological or lower abdominal procedures [1][2][3]. Ropivacaine is less cardiotoxic and has a greater separation of sensory and motor effects than bupivacaine [4][5][6]. It is increasingly used for paediatric caudal block. The concentrations of ropivacaine used in caudal analgesia range from 0.1% to 0.5% [3,[7][8][9][10]. Young animals are more sensitive to local anaesthetic toxicity than older ones [11,12], and nerves of young animals are also more sensitive to local anaesthetic-induced blockade [13]. So it may be possible to provide a safe and adequate surgical block with a lower concentration of local anaesthetics in younger children. The concept of minimum local analgesic concentration (MLAC) of local anaesthetics has been developed to serve as a benchmark for epidural dosing in labour [14]. The relations of age and the MLAC of ropivacaine for intra-operative caudal supplementation of general anaesthesia are not clear. We performed a prospective, double-blind study to determine the MLAC of ropivacaine to establish caudal analgesia combined with general anaesthesia in pre-school and school age children undergoing hypospadius repair. MethodsAfter approval by the Hospital Ethics Committee and informed, written consent from parents, 51 healthy (ASA physical status 1) boys, aged between 1 and 12 years old were enrolled. All children were scheduled for elective hypospadius repair under sevoflurane anaesthesia combined with caudal blockade. Children were stratified into pre-school (age 1-5 years) and school (age 6-12 years) age groups. Children were excluded in cases of local skin infections of the caudal area; neurological or neuromuscular disorders; delayed development; history of Anaesthesia, 2010, 65, pages 991-995

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“…Arterial blood samples (2 ml) for total plasma ropivacaine concentration were taken before the wound infiltration with study solution (time 0) and at 15, 30, 90 and 180 min after wound infiltration. Further venous blood samples were taken at 6, 12, 24, 48, 68 and 72 h. The plasma concentration of ropivacaine was measured using high-performance liquid chromatography as described previously [14]. The maximum concentration (C pmax ) and the time to reach C pmax (T max ) for ropivacaine in individual patients were recorded directly from the measured values.…”

Section: Methodsmentioning

confidence: 99%

The analgesic efficacy of continuous wound instillation with ropivacaine after open hepatic surgery

Chan

Lai

Li³

et al. 2010

Anaesthesia

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SummaryThe analgesic efficacy of continuous local anaesthetic wound instillation after open hepatic surgery was evaluated. Forty-eight patients scheduled for elective liver surgery were assigned to receive either ropivacaine 0.25% or saline infusion at 4 ml.h)1 for 68 h via two multi-orifice indwelling catheters placed within the musculo-fascial layer before skin closure; plasma ropivacaine concentrations were measured during the infusion. Supplemental analgesia was provided by intravenous patient-controlled analgesia morphine. Patients in the ropivacaine group had decreased mean (SD) total morphine consumption (58 (30) mg vs 86 (44) mg, p = 0.01) and less pain at rest as well as after spirometry at 4, 12, 24, 48 and 72 h postoperatively (p < 0.01). Forced vital capacity was reduced postoperatively in both groups, but the reduction was greater in the saline group at 12 and 24 h (p = 0.03). The mean plasma concentration of ropivacaine increased to 2.05 (0.78) lg.ml )1 at the point when the infusion was terminated.

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Ropivacaine Undergoes Slower Systemic Absorption from the Caudal Epidural Space in Children than Bupivacaine

Abstract: We compared the systemic absorption of ropivacaine (0.2%) and bupivacaine (0.2%) after caudal epidural injection of 2 mg/kg in children aged 1-7 yr. Our results show that ropivacaine undergoes slower systemic absorption from the caudal epidural space in children than does bupivacaine.

Cited by 41 publications

References 25 publications

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

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

Minimum local analgesic concentration of ropivacaine for intra‐operative caudal analgesia in pre‐school and school age children

The analgesic efficacy of continuous wound instillation with ropivacaine after open hepatic surgery

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