A Study of the dosage and duration for levobupivacaine infusion by the caudal-epidural route in infants aged 3-6 monthsCitation formats

  • External authors:
  • Rita Vashisht
  • Anju Bendon
  • Ijeoma Okonkwo
  • Davandra Patel
  • Catherine Fullwood

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A Study of the dosage and duration for levobupivacaine infusion by the caudal-epidural route in infants aged 3-6 months. / Vashisht, Rita; Bendon, Anju; Okonkwo, Ijeoma; Patel, Davandra; Fullwood, Catherine; Ogungbenro, Kayode; Aarons, Leon; Darwich, Adam.

In: Pediatric Anesthesia, 2018.

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Vashisht, Rita ; Bendon, Anju ; Okonkwo, Ijeoma ; Patel, Davandra ; Fullwood, Catherine ; Ogungbenro, Kayode ; Aarons, Leon ; Darwich, Adam. / A Study of the dosage and duration for levobupivacaine infusion by the caudal-epidural route in infants aged 3-6 months. In: Pediatric Anesthesia. 2018.

Bibtex

@article{52942c8a35674a8fa101f208a3237a22,
title = "A Study of the dosage and duration for levobupivacaine infusion by the caudal-epidural route in infants aged 3-6 months",
abstract = "AimTo investigate total serum levobupivacaine concentrations after a caudal‐epidural loading dose followed by a maintenance infusion in infants aged 3‐6 months over 48 hours.BackgroundThe local anaesthetic, levobupivacaine, is the safer enantiomer of racemic bupivacaine. Present protocols for levobupivacaine are based on studies and pharmacokinetic modelling with racemic bupivacaine. This study will inform clinical practice in this age group and validate the pharmacokinetic model for levobupivacaine infusions in infants, aged 3‐6months.MethodsThe clinical trial was conducted in 8 infants aged 3‐6 months, undergoing bladder exstrophy repair. Pharmacokinetic modelling allowed optimisation of clinical sampling to measure total levobupivacaine and α1‐acid glycoprotein and prediction of the effect of α1‐acid glycoprotein on levobupivacaine plasma protein binding.ResultsThe observed median total levobupivacaine serum concentration was 0.30 mg.L−1 (range: 0.20‐0.70 mg.L−1) at 1 hour after the loading dose of 2 mg.kg−1. The median total levobupivacaine concentration after 47 hours of infusion, at 0.2 mg.h−1.kg−1, was 1.21 mg.L−1 (0.07‐1.85 mg.L−1). Concentrations of α1‐acid glycoprotein were found to rise throughout the study period. Pharmacokinetic modelling suggested that unbound levobupivacaine quickly reached steady state at a concentration of approximately 0.03 mg.L−1.ConclusionThis study examines the pharmacokinetics of levobupivacaine after a loading dose (given over 5 minutes) followed by a maintenance infusion in infants 3‐6 months. The study allows the development of a pharmacokinetic model, combining levobupivacaine and α1‐acid glycoprotein data. Modelling indicates that unbound levobupivacaine quickly reaches steady state once the infusion is started. Simulations suggest that it may be possible to continue the infusion beyond 48 hours.",
keywords = "levobupivacaine, α1-acid glycoprotein, infants, caudal-epidural infusion, Bladder Exstrophy, pharmacokinetics",
author = "Rita Vashisht and Anju Bendon and Ijeoma Okonkwo and Davandra Patel and Catherine Fullwood and Kayode Ogungbenro and Leon Aarons and Adam Darwich",
year = "2018",
doi = "10.1111/pan.13548",
language = "English",
journal = "Paediatric Anaesthesia",
issn = "1155-5645",
publisher = "John Wiley & Sons Ltd",

}

RIS

TY - JOUR

T1 - A Study of the dosage and duration for levobupivacaine infusion by the caudal-epidural route in infants aged 3-6 months

AU - Vashisht, Rita

AU - Bendon, Anju

AU - Okonkwo, Ijeoma

AU - Patel, Davandra

AU - Fullwood, Catherine

AU - Ogungbenro, Kayode

AU - Aarons, Leon

AU - Darwich, Adam

PY - 2018

Y1 - 2018

N2 - AimTo investigate total serum levobupivacaine concentrations after a caudal‐epidural loading dose followed by a maintenance infusion in infants aged 3‐6 months over 48 hours.BackgroundThe local anaesthetic, levobupivacaine, is the safer enantiomer of racemic bupivacaine. Present protocols for levobupivacaine are based on studies and pharmacokinetic modelling with racemic bupivacaine. This study will inform clinical practice in this age group and validate the pharmacokinetic model for levobupivacaine infusions in infants, aged 3‐6months.MethodsThe clinical trial was conducted in 8 infants aged 3‐6 months, undergoing bladder exstrophy repair. Pharmacokinetic modelling allowed optimisation of clinical sampling to measure total levobupivacaine and α1‐acid glycoprotein and prediction of the effect of α1‐acid glycoprotein on levobupivacaine plasma protein binding.ResultsThe observed median total levobupivacaine serum concentration was 0.30 mg.L−1 (range: 0.20‐0.70 mg.L−1) at 1 hour after the loading dose of 2 mg.kg−1. The median total levobupivacaine concentration after 47 hours of infusion, at 0.2 mg.h−1.kg−1, was 1.21 mg.L−1 (0.07‐1.85 mg.L−1). Concentrations of α1‐acid glycoprotein were found to rise throughout the study period. Pharmacokinetic modelling suggested that unbound levobupivacaine quickly reached steady state at a concentration of approximately 0.03 mg.L−1.ConclusionThis study examines the pharmacokinetics of levobupivacaine after a loading dose (given over 5 minutes) followed by a maintenance infusion in infants 3‐6 months. The study allows the development of a pharmacokinetic model, combining levobupivacaine and α1‐acid glycoprotein data. Modelling indicates that unbound levobupivacaine quickly reaches steady state once the infusion is started. Simulations suggest that it may be possible to continue the infusion beyond 48 hours.

AB - AimTo investigate total serum levobupivacaine concentrations after a caudal‐epidural loading dose followed by a maintenance infusion in infants aged 3‐6 months over 48 hours.BackgroundThe local anaesthetic, levobupivacaine, is the safer enantiomer of racemic bupivacaine. Present protocols for levobupivacaine are based on studies and pharmacokinetic modelling with racemic bupivacaine. This study will inform clinical practice in this age group and validate the pharmacokinetic model for levobupivacaine infusions in infants, aged 3‐6months.MethodsThe clinical trial was conducted in 8 infants aged 3‐6 months, undergoing bladder exstrophy repair. Pharmacokinetic modelling allowed optimisation of clinical sampling to measure total levobupivacaine and α1‐acid glycoprotein and prediction of the effect of α1‐acid glycoprotein on levobupivacaine plasma protein binding.ResultsThe observed median total levobupivacaine serum concentration was 0.30 mg.L−1 (range: 0.20‐0.70 mg.L−1) at 1 hour after the loading dose of 2 mg.kg−1. The median total levobupivacaine concentration after 47 hours of infusion, at 0.2 mg.h−1.kg−1, was 1.21 mg.L−1 (0.07‐1.85 mg.L−1). Concentrations of α1‐acid glycoprotein were found to rise throughout the study period. Pharmacokinetic modelling suggested that unbound levobupivacaine quickly reached steady state at a concentration of approximately 0.03 mg.L−1.ConclusionThis study examines the pharmacokinetics of levobupivacaine after a loading dose (given over 5 minutes) followed by a maintenance infusion in infants 3‐6 months. The study allows the development of a pharmacokinetic model, combining levobupivacaine and α1‐acid glycoprotein data. Modelling indicates that unbound levobupivacaine quickly reaches steady state once the infusion is started. Simulations suggest that it may be possible to continue the infusion beyond 48 hours.

KW - levobupivacaine

KW - α1-acid glycoprotein

KW - infants

KW - caudal-epidural infusion

KW - Bladder Exstrophy

KW - pharmacokinetics

U2 - 10.1111/pan.13548

DO - 10.1111/pan.13548

M3 - Article

JO - Paediatric Anaesthesia

JF - Paediatric Anaesthesia

SN - 1155-5645

ER -