Abstract
The purpose of this study was to determine the pharmacokinetic properties of the local anaesthetic ropivacaine used with or without epinephrine for brachial plexus block. Seventeen ASA physical status I or II adult patients undergoing elective orthopaedic surgery received a single injection of 33 ml ropivacaine for subclavian perivascular block and 5 ml to block the intercostobrachial nerve in the axilla. One group (n =8) received 0.5 per cent ropivacaine without epinephrine (190 mg) and the other (n =9) received 0.5 per cent ropivacaine with epinephrine 1:200,000 (190 mg). Plasma ropivacaine concentrations were measured from peripheral venous blood samples taken for 12 hr after drug administration. Ropivacaine base was determined in plasma using gas chromatography and a nitrogen-sensitive detector. The mean peak plasma concentration (Cmax) was 1.6 ± 0.6 mg· L−1 and 1.3 ± 0.4 mg· L−1 after administration of ropivacaine with and without epinephrine. The median time to peak plasma concentration (tmax) was 0.75 hr and 0.88 hr and the mean area under the plasma concentration curve AUC0-12h was 7.7 ± 3.6 and 7.0 ± 3.4 mg · 1 hr−1. The differences were not statistically significant. The terminal phase of the individual plasma concentrationtime curves showed a varying and sometimes slow decline possibly indicating a sustained systemic uptake of ropivacaine from the brachial plexus. No central nervous system or cardiovascular symptoms attributed to systemic plasma concentrations of the drug were observed, with the dose (1.90–3.28 mg · kg−1) of ropivacaine used. It is concluded that the addition of epinephrine does not alter the pharmacokinetic properties of ropivacaine when used for subclavian perivascular brachial plexus block.
Résumé
Le but de cet étude était de déterminer la pharmacocinetique de l’anesthésique local ropivacaine utilisé avec ou sans épinéphrine pour un bloc de plexus brachiale. Dixsept patients adultes ASA I ou 2 devant subir des chirurgies orthopédiques électives out reçu une injection unique de 33 ml de ropivacaine pour un bloc perivasculaire sous claviere 5 ml afin de bloquer le nerf intercostal brachial à I’aisselle. Un groupe (n =8) a reçu 0.5 pour cent de ropivacaine sans épinéphrine (190 mg) et l’autre (n =9) a reçu 0.5 pour cent de ropivacaine avec epinephrine 1:200,000 (190 mg). Les concentrations plasmatiques de ropivacaine out été mesurées à partir d’échantillons veineux périphériques 12 heures apres l’administration de la drogue. La base de ropivacaine a été déterminee dans le plasma utilisant la chromotographie et un détecteur sensible à l’azote. Les concentrations plasmatiques moyennes les plus élevées (Cmax) était de 1.6 ± 0.6 mg · L−1 et 1.3 ± 0.4 mg· L−1 après administration de ropivacaine avec ou sans épinéphrine. Le temps moyen pour atteindre la concentration plasmatique maximale (tmax) était de 0.75 heures et 0.88 heures vu la moyenne de la surface sous la courbe de concentration plasmatique AUC0–12h était de 7.7 ± 3.6 et7.0 ± 3.4 mg ·1 hr−1−1. Les differences n’ ètaient pas statistiquement significatives. La phase terminale des courbes des concentrations plasmatiquestemps out demontre un declin variable el des fois lent indiquant possiblement une rétention systemique soutenue ds ropivacaine a partir du plexus brachial. Aucun symptome cardiovasculaire ou nerveux central attribue aux concentrations plasmatiques de la drogue furent observe avec des doses de (1.90–3.28 mg · kg−1)de ropivacaine utilisée. On conclut que l’addition d’épinéphrine n’allère pas la pharmacocinetique de la ropivacaine lorsqu’utilisée pour un bloc de plexus brachial.
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References
Rosenberg PH, Kytta J, Alila A. Absorption of bupivacaine, ctidocaine, lignocaine and ropivacaine into n-heptane, rat sciatic nerve, and human extradural and subcutaneous fat. Br J Anaesth 1986; 58: 310–4.
Akerman B, Hellberg I-B, Trossvik C. Primary evaluation of the local anaesthetic properties of the amino amide agent ropivacaine (LEA 103). Acta Anaesthesiol Scand 1988; 32: 571–8.
Reiz S, Haggmark S, Johansson G, Nath S. Cardiotoxicily of ropivacaine — a new amide local anaesthetic agent. Acta Anaesthesiol Scan 1989; 33: 93–8.
Scott DB, Lee A, Fagan D, Bowler GMR, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69: 563–9.
Lee A, Fagan D, Lamont M, Tucker GT, Halldin M, Scott DB. Disposition kinetics of ropivacaine in humans. Anesth Analg 1989; 69: 736–8.
Hickey R, Candido KD, Ramamurthy S et al. Brachial plexus block with a new local anaesthetic: 0.5 per cent ropivacaine. Can J Anaesth 1990; 37: 732–8.
Winnie AP. Perivascular techniques of brachial plexus block.In: Winnie AP (Ed.). Plexus Anesthesia. Philadelphia: W.B. Saunders, 1983; 145–63.
Gibaldi M, Perrier D. Pharmacokinetics. New York: Marcel Dekker, Inc., 1982.
Raj PP, Rosenblatt R, Miller J, Katz RL, Carden E. Dynamics of local anesthetic compounds in regional anesthesia. Anesth Analg 1977; 56: 110–7.
Pihlajamaki KK, Lindberg RLP. Bupivacaine with and without adrenaline in interscalene brachial plexus blockade. Studies in patients with rheumatoid arthritis. Br J Anaesth 1987; 59: 1420–4.
Wildsmith JAW, Tucker GT, Cooper S, Scott DB, Covino BG. Plasma concentrations of local anaesthetics after interscalene brachial plexus block. Br J Anaesth 1977; 49: 461–6.
Kopacz DJ, Carpenter RL, Mackey DC. Effect of ropivacaine on cutaneous capillary blood flow in pigs. Anesthesiology 1989; 71: 69–74.
Scott DB. Evaluation of clinical tolerance of local anaesthetic agents. Br J Anaesth 1975; 47: 328–33.
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The study was supported by a grant from Astra Pain Control and was conducted at Audie L. Murphy Memorial Veteran’s Administration Hospital and Medical Center Hospital in San Antonio, Texas.
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Hickey, R., Blanchard, J., Hoffman, J. et al. Plasma concentrations of ropivacaine given with or without epinephrine for brachial plexus block. Can J Anaesth 37, 878–882 (1990). https://doi.org/10.1007/BF03006624
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DOI: https://doi.org/10.1007/BF03006624