Evaluation of levobupivacaine passage to breast milk following epidural anesthesia for cesarean delivery (original) (raw)
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Acta Anaesthesiologica Scandinavica, 1999
There is a lack of information and knowledge about the practical importance of even low concentrations of the excretion of local anesthetics into breast milk, particularly concerning bupivacaine. The present work aims to confirm, under practical clinical conditions of admission of parturients, the passage of local anesthetics (lidocaine and bupivacaine) into breast milk after an epidural anesthesia. Methods: Twenty-seven pregnant women admitted for cesarean delivery received epidural anesthesia with 0.5% bupivacaine and 2% lidocaine. Blood and milk samples were simultaneously collected at 2, 6 and 12 h after the beginning of the epidural infusion. Lidocaine, bupivacaine and its main metabolite, pipecolylxylidide (PPX), were determined in serum and milk by a gas-liquid chromatographic technique. APGAR scores were systematically performed at delivery and a clinical examination was done 24 h after delivery. Results: Our data indicate that lidocaine and bupivacaine as
Fundamental & Clinical Pharmacology, 1997
Summary— Bupivacaine is the most widely used local anaesthetic in obstetrics for epidural analgesia. Nineteen women (mean age 26.9 ± 5.3 years) who underwent epidural analgesia during labour were included in this study. All parturients received a first injection of 21.8 ± 2.5 mg 0.25% plain bupivacaine. The following administrations were given on request: 0.25% concentration was used when cervix uteri was supple, and a 0.375% concentration when it was tonic. Blood samples were collected 5 min after the first injection and then every 30 min until delivery. At delivery blood samples were collected from the infant umbilical cord vein and from the arm vein of the mother. Bupivacaine was assayed by high pressure liquid chromatography. Serum data were analyzed for each patient using a non-compartmental model. Bupivacaine was rapidly detected in serum, and maximal concentration was reached between 5 and 35 min. Pharmacokinetic parameters were estimated in 17 women after the first injection: 87 ± 35 min for elimination half-life, 60 ± 19 L for apparent volume of distribution and 0.5 ± 0.3 L/min for plasmatic clearance. For a mean total duration of labour and total dose administered of respectively 222 ±115 min and 57.1 ± 28.7 mg, the mean value of the foeto-maternal ratio was 0.29 ±0.10. The infant maximal serum concentration was 0.26 μg/mL. No side effects were spontaneously reported by the parturients and all infants had an Apgar score of 10 at 5 min after the delivery. We confirm the fast systemic absorption and rapid elimination of bupivacaine which may be used without risk of acute toxicity both in mother and child, even when it is used in a 0.375% concentration.
International Journal of Obstetric Anesthesia, 1997
Ropivacaine is a new amino amide local anesthetic less lipophilic and with a lower affinity for plasma proteins than bupivacaine. The purpose of this study was to examine the feto-maternal distribution of ropivacaine and bupivacaine after epidural administration for cesarean section. Healthy parturients were randomly allocated in a double-blinded manner to receive either 0.5% ropivacaine or 0.5% bupivacaine through a lumbar epidural catheter. The total and free concentrations of ropivacaine and bupivacaine were determined in the maternal and umbilical plasma. The total dose (mg/kg) required for adequate surgical anesthesia and the resulting maximum total concentrations did not differ significantly between ropivacaine and bupivacaine. The free plasma clearance of bupivacaine was higher than that of ropivacaine (7382 vs 3344 ml/min, P=O.OOOl). The apparent terminal elimination half-life of ropivacaine was shorter than that of bupivacaine (6.0 vs 8.8 h, P=O.O07). At delivery, the maternal free plasma concentration of ropivacaine was more than twice that of the free concentration of bupivacaine (0.072 vs 0.032 pg/ml, P=O.O02). The free concentration of ropivacaine was about twice that of bupivacaine in the umbilical venous (0.06 vs 0.03 ug/ml, P=O.OOl) and umbilical arterial (0.05 vs 0.02 ug/ml, P=O.O07) plasma. The more rapid plasma clearance of bupivacaine compared to ropivacaine, leading to lower maternal plasma concentrations and hence to lower umbilical concentrations at delivery, could be explained by the higher lipid solubility, hence greater distribution volume, of bupivacaine.
Levobupivacaine versus racemic bupivacaine for extradural anesthesia for cesarean delivery
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005
Bupivacaine is available as a racemic mixture of dextrobupivacaine and levobupivacaine. Many studies show that dextrobupivacaine has a greater inherent central nervous system and cardiovascular toxicity than levobupivacaine. The aim of the present study was to investigate the clinical efficacy and safety of levobupivacaine compared with racemic bupivacaine for extradural anesthesia. METERIAL AND METHOD: The authors studied 61 patients undergoing elective cesarean delivery who received either 0.5% levobupivacaine (n = 31) or 0.5% bupivacaine (n = 30) extradurally, in a randomized, double blind study. The 2 groups were similar in terms of time to block suitable for surgery, duration of sensory block, time to T10 regression, time to onset and offset of motor block, verbal numeric pain scores at abdominal opening and at child birth. Mean (SD) dose of 0.5% levobupivacaine and 0.5% bupivacaine were 19.3 (4.6) ml and 17.3 (3.8) ml respectively, p = 0.069. Levobupivacaine produces an extrad...
Introduction: Spinal anaesthesia is a balance technique used for cesarean delivery. It provides rapid onset of anesthesia and complete muscle relaxation. Objective: To assess and compare the onset of sensory and motor block, duration of sensory and motor block, neonatal outcome, cardiovascular parameters and adverse drug reactions. Material and Methods: This was a prospective, randomized, double blind study. A total of 60 patients were enrolled and divided into 30 in each group. Group A was given 8.5 mg Isobaric Levobupivacaine with 15 g ?g Fentanyl and Group B was given 8.5 mg Hyperbaric Bupivacaine with 15 ?g Fentanyl. Result: The difference in the onset of sensory block and motor block and duration of sensory and motor block was statistically significant in two groups. Conclusion: The combination of Isobaric Levobupivacaine with Fentanyl can be used as a safe and effective alternative to Hyperbaric Bupivacaine with Fentanyl for spinal anaesthesia in cesarean section as, it provides comparable sensory block characteristics, early motor recovery allowing early mobilization, stable haemodynamics and good foetal well being.
Comparison of intrathecal bupivacaine, levobupivacaine for cesarean section
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014
BACKGROUND Some investigators found a greater incidence of hypotension in patients receiving intrathecal hyperbaric solution than in patients receiving plain solution for cesarean section. OBJECTIVE Compare the effects of intrathecal hyperbaric bupivacaine 10 mg with intrathecal bupivacaine 11 mg and intrathecal levobupivacaine 11 mg, all with 10 microg of fentanyl, for cesarean section. MATERIAL AND METHOD This prospective, randomized, double-blinded study was approved by the Ethics Committee. Ninety ASA I-II parturients undergoing elective cesarean section were enrolled. Group H received 10 mg of 0.5% hyperbaric bupivacaine plus fentanyl 10 g, Group B received 11 mg of 0.5% bupivacaine plus fentanyl 10 g, and Group L received 11 mg of 0.5% levobupivacaine plus fentanyl 10 g. Spinal anesthesia (SA) was undertaken in right lateral position and spinal solutions were injected approximately 30 to 40 seconds. Sensory and motor block were assessed at 5-minute intervals. Side-effects such...
Obstetric Anesthesia Digest, 2018
Background: Transversus abdominis plane block is increasingly used for post-Caesarean section analgesia. Cases of toxicity and the limited pharmacokinetic information during pregnancy motivated this study. The objective of the study was to characterise and compare the pharmacokinetics of levobupivacaine with epinephrine in tranversus abdominis plane block, in post-Caesarean section patients and healthy volunteers. Methods: After approval by the Ethics Committee, we collected data from 12 healthy parturients after elective Caesarean section (Study 1) and data from 11 healthy male volunteers from a previous study (Study 2). Transversus abdominus plane block was performed under ultrasound guidance. The following injectates were used: levobupivacaine 0.25%, 20 ml with epinephrine 5 mg ml À1 (Study 1) per side; 20 ml of the same solution (unilateral block) (study 2). The plasma venous concentration of levobupivacaine was measured serially for 90 min. Pharmacokinetic parameters (volume of distribution, clearance, and absorption half-life) were estimated using a non-linear mixed effects model (NONMEM). Simulation in 1000 patients estimated the maximum concentration and the time to reach it after bilateral transversus abdominis plane block. Results: Venous concentrations were below toxic levels (2.62 mg L À1). Levobupivacaine volume of distribution after Caesarean section was higher than in healthy volunteers [172 L (70 kg) À1 (95% confidence interval: 137e207) vs 94.3 L (70 kg) À1 (95% CI: 62e128); P<0.01]. Clearance and absorption half-life were similar. The simulation showed that maximum levobupivacaine concentration is lower and occurs later in postpartum patients (P<0.01). Postoperative analgesia was effective. Conclusions: Postpartum women reached relatively low plasma concentrations of levobupivacaine after transversus abdominal plane block given a volume of distribution 80% higher than volunteers, which could confer a greater margin of safety. Clinical trial registration: NCT02852720.
Aims: The aim of our study was to compare the onset and duration of sensory and motor block, hemodynamic effects, neonatal outcome and adverse effects of isobaric levobupivacaine and hyperbaric bupivacaine in parturients undergoing elective lower segment cesarean section. Methodology: Clinical records of parturients, who had undergone elective cesarean section and who had received either isobaric levobupivacaine 2 ml or hyperbaric bupivacaine 2 ml, and fulfilled inclusion and exclusion criteria were reviewed retrospectively and sorted out in two groups of 30 each. Variables investigated included demographic profile, ASA grading, block characteristics, hemodynamic parameters, neonatal apgar score and any anesthesia related complications. Results: One hundred and forty medical records were evaluated. Demographic profile, block characteristics and anesthesia related complications were similar in both of the groups and statistically insignificant. There was more drop in systolic blood pressure in bupivacaine group at second (p=0.001) and fourth minute (p=0.006), when compared to levobupivacaine group. Conclusion: Isobaric levobupivacaine is a good alternative to hyperbaric bupivacaine for subarachnoid block due to its better hemodynamic stability in cesarean sections. Citation: Narayanappa AB, Gurulingaswamy S, Prabhakaraiah UN. A retrospective comparison of intrathecal levobupivacaine with bupivacaine for elective lower segment cesarean section. Anaesth Pain & Intensive Care 2016;20(1):26-31
2012
Background: It has been reported that 10-15 mg local anaesthetic is enough for cesarean sections. Reduced doses of levobupivacaine may decrease the incidence of associated complications e.g. hypotension, nausea, vomiting and the vasopressor use. The primary objective of this study was to compare 7 mg and 10 mg doses of intrathecal levobupivacaine on maternal hemodynamics. The secondary objective was to determine the differences in sensory block, the vasopressor use, associated side effects and a need for additional analgesics between the groups. Methodology: Following ethical committee approval, thirty three women presenting for elective cesarean delivery were randomly assigned to one of the 2 groups. Group-7 received 7 mg intrathecal levobupivacaine and Group-10 received 10 mg. Women in both groups received 10 ml/kg crystalloids intravenously, at the time of initiation of combined spinal – epidural anesthesia. Surgery began when a sensory level was at T4. Maternal hemodynamics and ...