Slw. Cheung et al., SERUM CONCENTRATIONS OF BUPIVACAINE DURING PROLONGED CONTINUOUS PARAVERTEBRAL INFUSION IN YOUNG INFANTS, British Journal of Anaesthesia, 79(1), 1997, pp. 9-13
We have studied the efficacy of prolonged, continuous paravertebral in
fusion of bupivacaine for the management of post-thoracotomy pain in 2
2 infants with a median age of 1.5 weeks (range 1 day to 20.4 weeks).
Immediately before chest closure, 0.25% bupivacaine 1.25 mg kg(-1) was
given into an extrapleural paravertebral catheter, inserted under dir
ect vision. Subsequently, 0.125% bupivacaine with adrenaline 1:400 000
was infused at a rate of 0.2 ml kg(-1) h(-1) for 48 h. We confirmed t
hat extrapleural paravertebral catheter placement under direct vision
was easy in neonates and infants. The technique provided effective pos
toperative pain relief in 86% of patients, with three patients requiri
ng morphine in addition. Mean serum concentration of bupivacaine after
48 h was 1.60 (0.67) mu g ml(-1), but bupivacaine concentrations >3 m
u g ml(-1) were found in three patients at 30-48 h. There were no majo
r complications relating to the technique, and paravertebral block was
an effective method of providing prolonged post-thoracotomy analgesia
in these young infants.