Disposition of levobupivacaine during intraoperative continuous caudal epidural analgesia in a preterm neonate
Background. Continuous caudal epidural analgesia used intraoperatively in children is an effective and safe technique. However, in preterm neonates, developmental factors may significantly affect levobupivacaine disposition, leading to variable pharmacokinetics, pharmacodynamics, and potential large...
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Palacký University Olomouc, Faculty of Medicine and Dentistry
2024-03-01
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| Series: | Biomedical Papers |
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| Online Access: | https://biomed.papers.upol.cz/artkey/bio-202401-0011_disposition-of-levobupivacaine-during-intraoperative-continuous-caudal-epidural-analgesia-in-a-preterm-neonate.php |
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| author | Jan Sipek Pavla Pokorna Martin Sima Jitka Styblova Vladimir Mixa |
| author_facet | Jan Sipek Pavla Pokorna Martin Sima Jitka Styblova Vladimir Mixa |
| author_sort | Jan Sipek |
| collection | DOAJ |
| description | Background. Continuous caudal epidural analgesia used intraoperatively in children is an effective and safe technique. However, in preterm neonates, developmental factors may significantly affect levobupivacaine disposition, leading to variable pharmacokinetics, pharmacodynamics, and potential large-variable systemic toxicity of local anesthetics.
Objective. To our knowledge, this is the first case report describing the disposition of levobupivacaine used for intraoperative caudal epidural analgesia in a preterm neonate treated for the postoperative pain profile.
Method. 4-days old neonate (postmenstrual age 35+5, weight 2140 g) with congenital anal atresia received continuous caudal epidural long-term analgesia (loading dose 1.694 mg/kg, initial infusion 0.34 mg/kg/hour) before correction surgery. The blood samples were obtained at 1.0, 1.5, 6.5, 12, and 36.5 h after the start of epidural infusion. The pharmacokinetic profile of levobupivacaine was determined by using the Stochastic Approximation Expectation Maximization algorithm. COMFORT and NIPS pain scores were used for the assessment of epidural analgesia.
Results. The levobupivacaine absorption rate constant, apparent volume of distribution, apparent clearance, and elimination half-life were 10.8 h-1, 0.9 L, 0.086 L/h, and 7.3 h, respectively.
Conclusion. The results confirm our hypothesis of altered pharmacokinetics in the preterm neonate. Therefore, levobupivacaine therapy in these patients should be carefully monitored. Since therapeutic drug monitoring of levobupivacaine is not established in clinical routines, we suggest monitoring the intraoperative pain profile using validated scores.
Trial Registration: EudraCT number: 2020-000595-37 |
| first_indexed | 2024-04-25T00:41:13Z |
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| institution | Directory Open Access Journal |
| issn | 1213-8118 1804-7521 |
| language | English |
| last_indexed | 2024-04-25T00:41:13Z |
| publishDate | 2024-03-01 |
| publisher | Palacký University Olomouc, Faculty of Medicine and Dentistry |
| record_format | Article |
| series | Biomedical Papers |
| spelling | doaj.art-d5e1f0c96ecc48d39fb033097aa94ade2024-03-12T09:46:45ZengPalacký University Olomouc, Faculty of Medicine and DentistryBiomedical Papers1213-81181804-75212024-03-011681818410.5507/bp.2023.047bio-202401-0011Disposition of levobupivacaine during intraoperative continuous caudal epidural analgesia in a preterm neonateJan Sipek0Pavla Pokorna1Martin Sima2Jitka Styblova3Vladimir Mixa4Department of Anaesthesia, Resuscitation and Intensive Medicine, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol, Prague, Czech RepublicInstitute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech RepublicInstitute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech RepublicDepartment of Paediatric Surgery, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol, Prague, Czech RepublicDepartment of Anaesthesia, Resuscitation and Intensive Medicine, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol, Prague, Czech RepublicBackground. Continuous caudal epidural analgesia used intraoperatively in children is an effective and safe technique. However, in preterm neonates, developmental factors may significantly affect levobupivacaine disposition, leading to variable pharmacokinetics, pharmacodynamics, and potential large-variable systemic toxicity of local anesthetics. Objective. To our knowledge, this is the first case report describing the disposition of levobupivacaine used for intraoperative caudal epidural analgesia in a preterm neonate treated for the postoperative pain profile. Method. 4-days old neonate (postmenstrual age 35+5, weight 2140 g) with congenital anal atresia received continuous caudal epidural long-term analgesia (loading dose 1.694 mg/kg, initial infusion 0.34 mg/kg/hour) before correction surgery. The blood samples were obtained at 1.0, 1.5, 6.5, 12, and 36.5 h after the start of epidural infusion. The pharmacokinetic profile of levobupivacaine was determined by using the Stochastic Approximation Expectation Maximization algorithm. COMFORT and NIPS pain scores were used for the assessment of epidural analgesia. Results. The levobupivacaine absorption rate constant, apparent volume of distribution, apparent clearance, and elimination half-life were 10.8 h-1, 0.9 L, 0.086 L/h, and 7.3 h, respectively. Conclusion. The results confirm our hypothesis of altered pharmacokinetics in the preterm neonate. Therefore, levobupivacaine therapy in these patients should be carefully monitored. Since therapeutic drug monitoring of levobupivacaine is not established in clinical routines, we suggest monitoring the intraoperative pain profile using validated scores. Trial Registration: EudraCT number: 2020-000595-37https://biomed.papers.upol.cz/artkey/bio-202401-0011_disposition-of-levobupivacaine-during-intraoperative-continuous-caudal-epidural-analgesia-in-a-preterm-neonate.phplevobupivacainelocal anaesthesiapharmacokineticsneonatesdosing |
| spellingShingle | Jan Sipek Pavla Pokorna Martin Sima Jitka Styblova Vladimir Mixa Disposition of levobupivacaine during intraoperative continuous caudal epidural analgesia in a preterm neonate Biomedical Papers levobupivacaine local anaesthesia pharmacokinetics neonates dosing |
| title | Disposition of levobupivacaine during intraoperative continuous caudal epidural analgesia in a preterm neonate |
| title_full | Disposition of levobupivacaine during intraoperative continuous caudal epidural analgesia in a preterm neonate |
| title_fullStr | Disposition of levobupivacaine during intraoperative continuous caudal epidural analgesia in a preterm neonate |
| title_full_unstemmed | Disposition of levobupivacaine during intraoperative continuous caudal epidural analgesia in a preterm neonate |
| title_short | Disposition of levobupivacaine during intraoperative continuous caudal epidural analgesia in a preterm neonate |
| title_sort | disposition of levobupivacaine during intraoperative continuous caudal epidural analgesia in a preterm neonate |
| topic | levobupivacaine local anaesthesia pharmacokinetics neonates dosing |
| url | https://biomed.papers.upol.cz/artkey/bio-202401-0011_disposition-of-levobupivacaine-during-intraoperative-continuous-caudal-epidural-analgesia-in-a-preterm-neonate.php |
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