Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2017.09.007
Brazilian Journal of Anesthesiology
Scientific Article

Pharmacokinetic and clinical effects of two bupivacaine concentrations on axillary brachial plexus block

Efeitos farmacocinéticos e clínicos de duas concentrações de bupivacaína no bloqueio do plexo braquial via axilar

Leonardo H.C. Ferraro; Alexandre Takeda; Cleber N. Barreto; Bernadete Faria; Nilson A. Assunção

http://dx.doi.org/10.1016/j.bjane.2017.09.007 Braz J Anesthesiol, vol.68, n2, p.115-121, 2018
PDF English
PDF Português
Downloads: 0
Views: 914

Abstract

Abstract Introduction: The risk of systemic bupivacaine toxicity is a persistent problem, which makes its pharmacokinetic study fundamental for regional anesthesia safety. There is little evidence of its influence on plasma peak at different concentrations. The present study compares two bupivacaine concentrations to establish how the concentration affects this drug plasma peak in axillary brachial plexus block. Postoperative latency and analgesia were also compared. Methods: 30 patients were randomized. In the 0.25% Group, 0.25% bupivacaine (10 mL) was injected per nerve. In the 0.5% Group, 0.5% bupivacaine (5 mL) was injected per nerve. Peripheral blood samples were collected during the first 2 h after the blockade. For sample analyses, high performance liquid chromatography mass spectrometry was used. Results: Plasma peak occurred 45 min after the blockade, with no difference between groups at the assessed time-points. Plasma peak was 933.97 ± 328.03 ng.mL−1 (mean ± SD) in 0.25% Group and 1022.79 ± 253.81 ng.mL−1 in 0.5% Group (p = 0.414). Latency was lower in 0.5% Group than in 0.25% Group (10.67 ± 3.71 × 17.33 min ± 5.30, respectively, p = 0.004). No patient had pain within the first 4 h after the blockade. Conclusion: For axillary brachial plexus block, there was no difference in bupivacaine plasma peak despite the use of different concentrations with the same local anesthetic mass. The concentration inversely influenced latency.

Keywords

Bupivacaine, Brachial plexus, Pharmacokinetics, Regional anesthesia

Resumo

Resumo Introdução: O risco de intoxicação sistêmica pelo uso da bupivacaína é um problema persistente e torna seu estudo farmacocinético fundamental para a segurança da anestesia regional. São escassas as evidências sobre a influência de diferentes concentrações no pico plasmático desse fármaco. O presente estudo compara duas concentrações de bupivacaína para estabelecer como a concentração afeta o pico plasmático desse fármaco no bloqueio do plexo braquial via axilar. Também se compararam latência e analgesia pós-operatória. Métodos: Foram randomizados 30 pacientes. No Grupo 0,25%, injetaram-se 10 mL de bupivacaína 0,25% por nervo. No Grupo 0,5%, injetaram-se 5 mL de bupivacaína 0,5% por nervo. Amostras de sangue periférico foram colhidas durante as duas primeiras horas após o bloqueio. Para análise das amostras, usou-se a cromatografia líquida de alta frequência acoplada ao espectrômetro de massas. Resultados: O pico plasmático ocorreu 45 minutos após o bloqueio, sem diferença entre os grupos nos tempos avaliados. O pico plasmático (média ± DP) foi 933,97 ± 328,03 ng.mL−1 no Grupo 0,25% e 1.022,79 ± 253,81 ng.mL−1 no Grupo 0,5% (p = 0,414). O Grupo 0,5% apresentou menor latência com relação ao Grupo 0,25% (10,67 ± 3,71 × 17,33 min ± 5,30; respectivamente; p = 0,004). Nenhum paciente apresentou dor nas primeiras quatro horas após o bloqueio. Conclusão: Para o bloqueio do plexo braquial via axilar, não foi detectada diferença no pico plasmático de bupivacaína apesar do uso de diferentes concentrações, com a mesma massa de anestésico local. A concentração influenciou inversamente a latência.

Palavras-chave

Bupivacaína, Plexo braquial, Farmacocinética, Anestesia regional

References

Liu SS, Ortolan S, Sandoval MV. Cardiac arrest and seizures caused by local anesthetic systemic toxicity after peripheral nerve blocks: should we still fear the reaper?. Reg Anesth Pain Med. 2016;4:5-21.

Vasques F, Behr AU, Weinberg G. A review of local anesthetic systemic toxicity cases since publication of the American Society of Regional Anesthesia Recommendations: to whom it may concern. Reg Anesth Pain Med. 2015;40:698-705.

Dillane D, Finucane BT. Local anesthetic systemic toxicity. Can J Anaesth. 2010;57:368-80.

Lee LA, Posner KL, Cheney FW. Complications associated with eye blocks and peripheral nerve blocks: an ASA closed-claims analysis. Reg Anesth Pain Med. 2008;33:416-22.

Auroy Y, Narchi P, Messiah A. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87:479-86.

Mulroy MF. Systemic toxicity and cardiotoxicity from local anesthetics: incidence and preventive measures. Reg Anesth Pain Med. 2002;27:556-61.

Choi S, Mccarthney CJ. Evidence base for the use of ultrasound for upper extremity blocks: 2014 update. Reg Anesth Pain Med. 2016;41:242-50.

Abrahams MS, Aziz MF, Fu RF. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102:408-17.

Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004;29:564-75.

Cohen LS, Rosenthal JE, Horner Jr. DW. Plasma levels of lidocaine after intramuscular administration. Am J Cardiol. 1972;29:520-3.

Pintaric TS, Kozelj G, Stanovnik L. Pharmacokinetics of levobupivacaine 0.5% after superficial or combined (deep and superficial) cervical plexus block in patients undergoing minimally invasive parathyroidectomy. J Clin Anesth. 2008;20:333-7.

Morrison LM, Emanuelsson BM, McClure JH. Efficacy and kinetics of extradural ropivacaine: comparison with bupivacaine. Br J Anaesth. 1994;72:164-9.

Takeda A, Ferraro LH, Rezende AH. Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound. Rev Bras Anestesiol. 2015;65:163-9.

O’Donnell BD, Iohom G. An estimation of the minimum effective anesthetic volume of 2% lidocaine in ultrasound-guided axillary brachial plexus block. Anesthesiology. 2009;111:25-9.

Ferraro LH, Takeda A, dos Reis Falcão LF. Determination of the minimum effective volume of bupivacaine 0.5% for ultrasound-guided axillary brachial plexus block. Rev Bras Anestesiol. 2014;64:49-53.

Gaskell SJ. Electrospray: principles and practice. J Mass Spectrom. 1997;32:677-88.

Guidance for Industry, Analytical Procedures and Methods Validation for Drugs and Biologics. .

Conover WJ. Practical nonparametric statistics. 1980:493.

Cuvillon P, Nouvellon E, Ripart J. A comparison of the pharmacodynamics and pharmacokinetics of bupivacaine, ropivacaine (with epinephrine) and their equal volume mixtures with lidocaine used for femoral and sciatic nerve blocks: a double-blind randomized study. Anesth Analg. 2009;108:641-9.

Hashizume Y, Yamaguchi S, Mishio M. Pediatric caudal block with mepivacaine, bupivacaine or a mixture of both drugs: requirement for postoperative analgesia and plasma concentration of local anesthetics. J Clin Anesth. 2001;13:30-4.

Harper GK, Stafford MA, Hill DA. Minimum volume of local anaesthetic required to surround each of the constituent nerves of the axillary brachial plexus, using ultrasound guidance: a pilot study. Br J Anaesth. 2010;104:633-6.

Scott DB, Lee A, Fagan D. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989;69:563-9.

Vainionpää VA, Haavisto ET, Huha TM. A clinical and pharmacokinetic comparison of ropivacaine and bupivacaine in axillary plexus block. Anesth Analg. 1995;81:534-8.

Freysz M, Beal JL, D’Athis P. Pharmacokinetics of bupivacaine after axillary brachial plexus block. Int J Clin Pharmacol Ther Toxicol. 1987;25:392-5.

5dcc49960e8825b25cbf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections