Pharmacokinetics and Analgesic Effect of Ropivacaine during Continuous Epidural Infusion for Postoperative Pain Relief

1996 ◽  
Vol 84 (4) ◽  
pp. 834-842. ◽  
Author(s):  
Carl-Johan Erichsen ◽  
Jan Sjovall ◽  
Henrik Kehlet ◽  
Cecilia Hedlund ◽  
Torbjorn Arvidsson
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Plasma Concentrations ◽  
Epidural Infusion ◽  
Postoperative Pain Relief ◽  
Total Plasma ◽  
Analog Scale ◽  
Continuous Epidural Infusion ◽  
Unbound Fraction

Background The pharmacokinetics and clinical efficacy of ropivacaine (2.5 mg/ml) during a 24-h continuous epidural infusion for postoperative pain relief in 20 patients scheduled for abdominal hysterectomy were characterized using an open-label, increasing-dose design. Methods Through an epidural catheter inserted at T10-T12, a test dose of 7.5 mg ropivacaine was given 3 min before a bolus dose of 42.5 mg and immediately followed by a 24-h continuous epidural infusion with either 10 or 20 mg/h. Peripheral venous plasma samples were collected up to 48 h after infusion, and urinary excretion was followed up to the end of infusion. Postoperative pain at rest, on coughing, and at mobilization was assessed by means of a visual analog scale 2,4,6,8,12, and 24 h after the end of surgery. Sensory (pinprick) and motor block (modified Bromage scale) were assessed at the same intervals. Results The total plasma concentrations of ropivacaine increased markedly and consistently during the 24-h epidural infusion, in contrast to stable unbound concentrations. Both total and unbound plasma concentrations at the end of infusion were proportional to the total dose, although only the latter was proportional to the infusion rate. The total and unbound plasma clearance was independent of dose. Total mean clearance decreased on average by 21% (P < 0.001) during the last 12 h of epidural infusion, i.e., from 539 +/- 191 ml/min to 418 +/- 138 ml/min, indicating time-dependent kinetics. The unbound clearance also varied between estimates after 8 h of infusion and the end of treatment, i.e., a 5.3% decrease from 10.4 +/- 5.3 l/min to 9.5 +/- 3.9 l/min (P < 0.05). The unbound fraction of ropivacaine in plasma decreased during treatment, and this was related to the increase in alpha1-acid glycoprotein concentration. Pain was generally well controlled, and median visual analog scale scores during mobilization were less than 30 mm in patients receiving ropivacaine at 20 mg/h. Conclusions The pharmacokinetics of ropivacaine were independent of dose, but total clearance decreased with time over 24 h. The consistent increase in total plasma concentration during the postoperative epidural infusion contrasted to much less variation in the unbound plasma concentrations of ropivacaine.

Pharmacokinetics of Bupivacaine during Postoperative Epidural Infusion

2002 ◽  
Vol 96 (5) ◽  
pp. 1062-1069 ◽  
Author(s):  
Bernadette Th. Veering ◽  
Anton G. L. Burm ◽  
Hilde-Marieken Feyen ◽  
Wim Olieman ◽  
John H. M. Souverijn ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Protein Binding ◽  
Bolus Dose ◽  
Plasma Concentrations ◽  
Epidural Infusion ◽  
Total Plasma ◽  
Continuous Epidural Infusion ◽  
Acid Glycoprotein ◽  
Constant Rate

Background Changing plasma protein concentrations may affect the protein binding and pharmacokinetics of drugs in the postoperative period. This study examined the effect of postoperative increases (in response to surgery) in plasma alpha1-acid-glycoprotein (AAG) concentrations on the plasma concentrations of the enantiomers of bupivacaine during continuous epidural infusion of racemic bupivacaine for postoperative pain relief. Methods Six patients scheduled for total hip surgery with combined epidural and general anesthesia received a bolus dose of bupivacaine (65 mg) followed by constant-rate (8 ml/h) epidural infusion of 2.5 mg/ml bupivacaine for 48 h. Total and unbound plasma concentrations of the enantiomers of bupivacaine and plasma AAG concentrations during the 48-h epidural infusion were determined. Results Total plasma concentrations of the enantiomers of bupivacaine increased steadily during the infusion (P < 0.0001), whereas unbound concentrations did not change after 12 h (P > 0.1). Total plasma concentrations of S(-)-bupivacaine were higher than those of R(+)-bupivacaine (P < 0.02), whereas unbound concentrations of S(-)-bupivacaine were lower than those of R(+)-bupivacaine (P < 0.002). AAG concentrations initially decreased, but thereafter increased steadily (P < 0.0001). Consequently, free fractions of the enantiomers initially increased and then decreased with time (P = 0.0002). Free fractions of S(-)-bupivacaine were smaller than those of R(+)-bupivacaine (P = 0.0003). Conclusions The study confirmed that the pharmacokinetics of bupivacaine are enantioselective. During postoperative epidural infusion, changing plasma AAG concentrations affect the protein binding of both enantiomers of bupivacaine. Consequently, total plasma concentrations of the enantiomers increase with time, whereas unbound concentrations reach a plateau.

Continuous Interscalene Analgesia with Ropivacaine 2 mg/ml after Major Shoulder Surgery

2003 ◽  
Vol 98 (1) ◽  
pp. 143-150 ◽  
Author(s):  
Georgios Ekatodramis ◽  
Alain Borgeat ◽  
Gunilla Huledal ◽  
Lennart Jeppsson ◽  
Lars Westman ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Plasma Concentrations ◽  
Shoulder Surgery ◽  
Interscalene Block ◽  
Postoperative Pain Relief ◽  
Analog Scale ◽  
Threshold Levels ◽  
Continuous Interscalene

Background In this open, randomized study, the pharmacokinetics, clinical efficacy, and safety of a 48-h continuous interscalene infusion of 2 mg/ml ropivacaine for postoperative pain relief were investigated in patients undergoing open major shoulder surgery. Methods An initial interscalene block with 30 ml ropivacaine, 7.5 mg/ml (225 mg), was performed. After completion of interscalene block, all patients (n = 24) received general anesthesia, and 6 h after interscalene block, a 48-h continuous interscalene infusion of 12 or 18 mg/h using 2 mg/ml ropivacaine was started. Total and unbound plasma concentrations of ropivacaine and 2.6-pipecoloxylidide (PPX; a major active metabolite) were determined during and up to 6 h after the interscalene infusion. Postoperative pain at rest was assessed by a visual analog scale. Supplementary analgesics and adverse events were recorded. Results Plasma concentrations of total and unbound ropivacaine were proportional to the total dose. At the end of the interscalene infusion of 9 ml/h, the mean +/- SD plasma concentrations of total and unbound ropivacaine were 1.40 +/- 0.54 and 0.03 +/- 0.01 mg/l, respectively, and of total and unbound PPX were 0.70 +/- 0.38 and 0.30 +/- 0.20 mg/l, respectively. Plasma concentrations of unbound ropivacaine and unbound PPX, added together, remained well below threshold levels for systemic central nervous system toxicity. There were no significant differences between the groups for postoperative pain (median maximum of about 20 mm on the visual analog scale in both groups), analgesic consumption, or quality of pain relief assessed by the patient. No signs or symptoms of systemic local anesthetic toxicity were observed. Conclusion A 48-h continuous interscalene infusion of 6 or 9 ml/h ropivacaine, 2 mg/ml, started 6 h after an initial interscalene block of 30 ml ropivacaine, 7.5 mg/ml, provided satisfactory postoperative pain relief after major shoulder surgery and was well tolerated. Unbound plasma concentrations of ropivacaine and PPX remained well below threshold levels for systemic central nervous toxicity.

scholarly journals Postoperative Pain Relief by Continuous Epidural Infusion of 0.25% Bupivacaine.

1992 ◽  
Vol 12 (7) ◽  
pp. 770-773
Author(s):  
Yoshihiro HIRABAYASHI ◽  
Hiromasa MITSUHATA ◽  
Kohjiro FURUYA ◽  
Shigeo IKENO ◽  
Noboru TSUKAMOTO ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Epidural Infusion ◽  
Postoperative Pain Relief ◽  
Continuous Epidural Infusion

Continuous Epidural Infusion of Bupivacaine for Postoperative Pain Relief in Children

1987 ◽  
Vol 67 (1) ◽  
pp. 108-109 ◽  
Author(s):  
Joëlle Desparmet ◽  
Claude Meistelman ◽  
Jérôme Barre ◽  
Claude Saint-Maurice
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Epidural Infusion ◽  
Postoperative Pain Relief ◽  
Continuous Epidural Infusion

scholarly journals A Prospective Case-control Study on the Comparison of Postoperative Pain Relief with Transdermal Diclofenac Patch and Injection Diclofenac

2015 ◽  
Vol 6 (4) ◽  
pp. 129-133
Author(s):  
Subbhabrata Das
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Case Control Study ◽  
Case Control ◽  
Postoperative Pain Relief ◽  
Analog Scale ◽  
Group A ◽  
Group B ◽  
Control Study

ABSTRACT Aim This is a randomized case-control study to know the efficacy of postoperative pain relief with transdermal diclofenac patch 200 mg and comparison with injection diclofenac sodium 75 mg. Materials and methods A total of 100 patients with head and neck cancer were included in the study and were randomly divided into two groups (A and B). Anesthetic procedure was standardized. A transdermal diclofenac diethylamine patch of 200 mg was applied to group A, just before the skin closure. And in group B, injection diclofenac was given 8 hourly. In group A, injection diclofenac was given on an as-needed basis whenever patient had visual analog scale (VAS) of pain > 5. Visual analog scale at 2nd, 4th, 8th, 12th, and 24th hour postoperatively was recorded for 5 days. Injection diclofenac needed in groups A and B was recorded for five postoperative days and the mean number of injections of diclofenac per patient per day needed in both groups was calculated. Results In group A, we needed only 0.96 injections (diclofenac 75 mg)/patient on the first day and no injection was needed further, while in group B, we had to use three injections/day/ patient. Visual analog scale and pain relief were more steady and better in group A as compared with group B. Conclusion Transdermal patch of diclofenac diethylamine 200 mg is very effective in providing postoperative analgesia and is better than intravenous injection diclofenac 75 mg. How to cite this article Singh SP, Jain DK, Das S, Jain S. A Prospective Case-control Study on the Comparison of Postoperative Pain Relief with Transdermal Diclofenac Patch and Injection Diclofenac. Int J Head Neck Surg 2015;6(4):129-133.

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