PLASMA-CONCENTRATIONS OF BUPIVACAINE DURI NG CONTINUOUS EPIDURAL-ANESTHESIA IN CHILDREN

Epidural anaesthesia is extremely useful in providing postoperative an algesia for children after surgery of the lower body. Although results on early pharmacokinetics in children have previously been reported, no data are available on the long-term effects of epidural anaesthesia . The aim of this investigation was the assessment of plasma bupivacai ne levels in children with continuous epidural anaesthesia in the post operative period. A catheter with an outer diameter of 0.63 mm was ins erted through a 19G Tuohy cannula into the epidural space. A maximum d ose of 0.4 mg/kg/h bupivacaine was administered for continuous epidura l infusion. Careful monitoring was performed to detect early signs of local anaesthetic intoxication. Two milliliters of blood were obtained in each patient per day and nepholometric serum measurement were perf ormed to determine alpha(1)-acid glycoprotein and albumin levels. Bupi vacaine plasma concentrations were assessed according to the method de scribed by Sattler et al.[25]. Ten children were included in the inves tigation. The measured albumin and alpha(1)-acid glycoprotein concentr ations were within the range described by other investigators. At the onset of pain therapy maximum levels of 0.5 mu g/ml where recorded aft er a loading dose of bupivacaine and levels of up to 2.2 mu g/ml were achieved following continuous infusion. There were no neurologic compl ications or signs of lokal anesthetic intoxication. In conclusion our results show that a dose of up to 0.4 mg/kg/h bupivacaine during conti nuous epidural infusion is not associated with toxic complications. Ca reful monitoring of the children by experienced staff is mandatory.