Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trialReport as inadecuate




Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trial - Download this document for free, or read online. Document in PDF available to download.

Background

Continuous wound infiltration CWI has become increasingly popular in recent years as an alternative to epidural analgesia. As catheters are not placed until the end of surgery, more intraoperative opioid analgesics might be needed. We, therefore, added a single pre-peritoneal bolus of bupivacaine at the start of laparotomy, similar to the bolus given with epidural analgesia.

Methods

This was a comparative study within a randomized controlled trial NTR4948. Patients undergoing hepato-pancreato-biliary surgery received either a pre-peritoneal bolus of 30ml bupivacaine 0.25%, or an epidural bolus of 10ml bupivacaine 0.25% at the start of laparotomy. In a subgroup of patients, we sampled blood and determined bupivacaine serum levels 20, 40, 60 and 80 minutes after bolus injection. We assumed toxicity of bupivacaine to be >1000 ng-ml.

Results

A total of 20 patients participated in this sub-study. All plasma levels measured as well as the upper limit of the predicted 99% confidence intervals per time point were well below the toxicity limit. In a mixed linear-effect model both groups did not differ statistically significant p = 0.131. The intra-operative use of opioids was higher with CWI as compared to epidural 86 SD 73 μg sufentanil vs. 50 SD 32.

Conclusions

In this exploratory study, the pre-peritoneal bolus using bupivacaine resulted in serum bupivacaine concentrations well below the commonly accepted toxic threshold. With CWI more additional analgesics are needed intraoperatively as compared to epidural analgesia, although this is compensated by a reduction in use of vasopressors with CWI.

Trial registration

Netherlands Trial Register NTR4948



Author: Timothy H. Mungroop , Ganapathy van Samkar , Bart F. Geerts, Susan van Dieren, Marc G. Besselink, Denise P. Veelo , Philipp Lirk,

Source: http://plos.srce.hr/



DOWNLOAD PDF




Related documents