Arterial and venous pharmacokinetics of ropivacaine with and without epinephrine after thoracic paravertebral block.
Background: Animal and volunteer studies indicate that ropivacaine is associated with less neurologic and cardiac toxicity than bupivacaine. Ropivacaine may offer advantages when used for thoracic paravertebral block. This study was designed to describe the pharmacokinetics of ropivacaine after thor...
| Publicado en: | Anesthesiology Vol. 103; no. 4; pp. 704 - 712 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | clinical trial equations & formulas research tables/charts Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Oct2005
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106104937&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106104937 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00033022 1V8 jtl: Anesthesiology issn: 00033022 maglogo: N pubinfo: dt: Oct2005 vid: 103 iid: 4 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 106104937 106104937 NLM16192762 2009580292 NLM16192762 106104937 ppf: 704 ppct: 8 formats: tig: atl: Arterial and venous pharmacokinetics of ropivacaine with and without epinephrine after thoracic paravertebral block. aug: au: Karmakar MK Ho AM Law BK Wong ASY Shafer SL Gin T Karmakar, Manoj K Ho, Anthony M-H Law, Bonita K Wong, April S Y Shafer, Steven L Gin, Tony affil: Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital sug: subj: Anesthetics, Local Pharmacokinetics Epinephrine Pharmacodynamics Nerve Block Absorption Adult Amides Pharmacokinetics Breast Surgery Clinical Trials Data Analysis Software Descriptive Statistics Drug Interactions Female Fisher's Exact Test Hong Kong Mann-Whitney U Test Middle Age Post Hoc Analysis Random Assignment T-Tests Thoracic Vertebrae Wilcoxon Rank Sum Test Human Adult: 19-44 years Middle Aged: 45-64 years Female ab: Background: Animal and volunteer studies indicate that ropivacaine is associated with less neurologic and cardiac toxicity than bupivacaine. Ropivacaine may offer advantages when used for thoracic paravertebral block. This study was designed to describe the pharmacokinetics of ropivacaine after thoracic paravertebral block.Methods: Twenty female patients undergoing elective unilateral breast surgery were randomly assigned to receive a single bolus thoracic paravertebral injection of 2 mg/kg ropivacaine, with or without 5 mug/ml epinephrine. Simultaneous arterial and venous blood samples were obtained for plasma ropivacaine assay. Data were analyzed with NONMEM, using two possible absorption models: conventional first-order absorption and absorption following the inverse gaussian density function.Results: Epinephrine reduced the peak plasma concentrations and delayed the time of peak concentration of ropivacaine in both the arterial and venous blood. The time course of drug input into the systemic circulation was best described by two inverse gaussian density functions. The median bioavailability of the rapid component was approximately 20% higher when epinephrine was not used. The mean absorption times were 7.8 min for the rapid absorption phase and 697 min for the slow absorption phase, with wide dispersion of the absorption function for the acute phase. The half-time of arterial-venous equilibration was 1.5 min.Conclusion: The absorption of ropivacaine after thoracic paravertebral block is described by rapid and slow absorption phases. The rapid phase approximates the speed of intravenous administration and accounts for nearly half of ropivacaine absorption. The addition of 5 mug/ml epinephrine to ropivacaine significantly delays its systemic absorption and reduces the peak plasma concentration. pubtype: Academic Journal doctype: clinical trial equations & formulas research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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